We analyzed the Scientific Registry of Transplant Recipients (2004-2022) for primary kidney recipients with HIV who had average immunologic risk and were discharged on tacrolimus/mycophenolate mofetil (with or without corticosteroids). Recipients were grouped by induction type: rabbit antithymocyte globulin (r-ATG, n=688) and human interleukin-2 receptor antagonist (IL2Ra, n=467). Kaplan-Meier curves were generated to examine recipient and graft survival by induction type. We used mixed Cox proportional hazard models to determine associations between induction type and outcomes of interest, with adjustments for recipient and donor factors and transplant center as a random effect. Regression with propensity score weighting reduced selection bias from nonrandom induction allocation. The unadjusted 10-year survival rate was 57% for those receiving r-ATG and 64% for those receiving IL2Ra (P<.001). Adjusted risk of death was significantly lower for IL2Ra induction than r-ATG induction with Cox multivariable (hazard ratio, 0.65; 95% CI, 0.47-0.91; P=.01) and inverse probability treatment weighting (hazard ratio, 0.38; 95% CI, 0.29-0.50; P<.01) models. Death-censored kidney graft survival did not differ by induction type in either model. The 1-year rejection rate was 10.1% and 11.6% for r-ATG and IL2Ra recipients, respectively (P=.52). Overall, IL2Ra conferred better long-term survival than r-ATG without increased risk of graft loss.

中文翻译：

---

具有平均免疫风险的 HIV 肾移植受者诱导免疫抑制的长期结果：逆概率治疗加权分析。


我们分析了移植受者的科学登记处 （2004-2022），了解具有平均免疫风险并使用他克莫司/吗替麦考酚酯出院（有或没有皮质类固醇）的原发性 HIV 受肾者。受者按诱导类型分组：兔抗胸腺细胞球蛋白 （r-ATG， n=688） 和人白细胞介素-2 受体拮抗剂 （IL2Ra， n=467）。生成 Kaplan-Meier 曲线以按诱导类型检查受体和移植物存活率。我们使用混合 Cox 比例风险模型来确定诱导类型与感兴趣结局之间的关联，并随机调整受体和供体因素以及移植中心。具有倾向得分加权的回归减少了非随机归纳分配的选择偏差。接受 r-ATG 的患者未经调整的 10 年生存率为 57%，接受 IL2Ra 的患者为 64% （P<.001）。IL2Ra 诱导的调整后死亡风险显著低于 Cox 多变量 r-ATG 诱导（风险比，0.65;95% CI，0.47-0.91;P=.01） 和逆概率治疗加权 （风险比，0.38;95% CI，0.29-0.50;P<.01） 模型。在两种模型中，死亡删失肾移植物存活率均不因诱导类型而异。r-ATG 和 IL2Ra 受体的 1 年排斥率分别为 10.1% 和 11.6% （P=.52）。总体而言，IL2Ra 比 r-ATG 具有更好的长期生存率，而不会增加移植物丢失的风险。