Posttransplant lymphoproliferative disorder (PTLD) poses a significant concern in Epstein-Barr virus (EBV)–negative patients transplanted from EBV-positive donors (EBV R-/D+). Previous studies investigating the association between different induction agents and PTLD in these patients have yielded conflicting results. Using the Organ Procurement and Transplant Network database, we identified EBV R-/D+ patients >18 years of age who underwent kidney-alone transplants between 2016 and 2022 and compared the risk of PTLD with rabbit antithymocyte globulin (ATG), basiliximab, and alemtuzumab inductions. Among the 6620 patients included, 64.0% received ATG, 23.4% received basiliximab, and 12.6% received alemtuzumab. The overall incidence of PTLD was 2.5% over a median follow-up period of 2.9 years. Multivariable analysis demonstrated that the risk of PTLD was significantly higher with ATG and alemtuzumab compared with basiliximab (adjusted subdistribution hazard ratio [aSHR] = 1.98, 95% confidence interval [CI] 1.29-3.04, = .002 for ATG and aSHR = 1.80, 95% CI 1.04-3.11, = .04 for alemtuzumab). However, PTLD risk was comparable between ATG and alemtuzumab inductions (aSHR = 1.13, 95% CI 0.72-1.77, = .61). Therefore, the risk of PTLD must be taken into consideration when selecting the most appropriate induction therapy for this patient population.

中文翻译：

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诱导治疗对供体-受体血清学 Epstein-Barr 病毒不匹配的成人肾移植受者移植后淋巴增殖性疾病风险的影响

移植后淋巴增殖性疾病 (PTLD) 是从 EBV 阳性供体 (EBV R-/D+) 移植的 Epstein-Barr 病毒 (EBV) 阴性患者的一个重要问题。先前的研究调查了这些患者中不同诱导剂与 PTLD 之间的关联，但得出了相互矛盾的结果。使用器官采购和移植网络数据库，我们确定了 2016 年至 2022 年间接受单纯肾移植的 18 岁以上 EBV R-/D+ 患者，并将 PTLD 风险与兔抗胸腺细胞球蛋白 (ATG)、巴利昔单抗和阿仑单抗进行了比较感应。在 6620 名患者中，64.0% 接受 ATG，23.4% 接受巴利昔单抗，12.6% 接受阿仑单抗。在 2.9 年的中位随访期内，PTLD 的总体发生率为 2.5%。多变量分析表明，与巴利昔单抗相比，ATG 和阿仑单抗的 PTLD 风险显着更高（调整后的亚分布风险比 [aSHR] = 1.98，95% 置信区间 [CI] 1.29-3.04，ATG 和 aSHR = 1.80 = 0.002，阿仑单抗的 95% CI 1.04-3.11，= 0.04）。然而，ATG 和阿仑单抗诱导之间的 PTLD 风险相当（aSHR = 1.13，95% CI 0.72-1.77，= .61）。因此，在为该患者群体选择最合适的诱导治疗时，必须考虑 PTLD 的风险。