Abstract：
BACKGROUND: Broad national or international programs contribute to mitigating the expected longer waiting list (WL) time for sensitized patients but with minor benefits for highly sensitized subjects. Therefore, strategies to prevent high sensitization are urgently required. In this study, we investigated the risk of developing highly sensitized patients with different immunosuppressive (IS) handling after kidney allograft failure (KAF).
METHODS: Data from 185 patients with KAF, retransplanted/relisted from 2010 to 2020 in two regions of Italy that share the same regional WL, were analyzed. Patients were categorized according to IS management at 12 months after KAF as follows: patients maintaining IS with calcineurin inhibitors (CNI) (late withdrawal group [LWG], n = 58) and those who withdrew all IS therapy or were on steroids only (early withdrawal group [EWG], n = 127).
RESULTS: Patients in the LWG showed lower panel reactive antibodies (PRA) at 12 (29.0% vs. 85.5%, p < 0.001) and 24 months (61.0% vs. 91.0%, p = 0.001), reduced risk of high sensitization (PRA ≥90%) at 12 (9.4% vs. 40.7%, p < 0.001, OR = 0.15) and 24 months (25.6% vs. 57.3%, p = 0.001, OR = 0.26) and almost no very high sensitization (PRA ≥ 98%) at 12 months (1.9% vs. 18.6%, p = 0.003, OR = 0.08) after KAF. In the LWG subgroup analysis, patients who maintained IS for up to 24 months after KAF did not show very high sensitization. The LWG showed shorter active WL times (406 vs. 813 days, p = 0.001) without an increased risk of complications.
CONCLUSIONS: CNI maintenance for at least 12 months after KAF could be a useful approach to prevent high sensitization and reduce WL times in patients who are offered retransplantation, without a higher burden of complications.
METHODS: Data from 185 patients with KAF, retransplanted/relisted from 2010 to 2020 in two regions of Italy that share the same regional WL, were analyzed. Patients were categorized according to IS management at 12 months after KAF as follows: patients maintaining IS with calcineurin inhibitors (CNI) (late withdrawal group [LWG], n = 58) and those who withdrew all IS therapy or were on steroids only (early withdrawal group [EWG], n = 127).
RESULTS: Patients in the LWG showed lower panel reactive antibodies (PRA) at 12 (29.0% vs. 85.5%, p < 0.001) and 24 months (61.0% vs. 91.0%, p = 0.001), reduced risk of high sensitization (PRA ≥90%) at 12 (9.4% vs. 40.7%, p < 0.001, OR = 0.15) and 24 months (25.6% vs. 57.3%, p = 0.001, OR = 0.26) and almost no very high sensitization (PRA ≥ 98%) at 12 months (1.9% vs. 18.6%, p = 0.003, OR = 0.08) after KAF. In the LWG subgroup analysis, patients who maintained IS for up to 24 months after KAF did not show very high sensitization. The LWG showed shorter active WL times (406 vs. 813 days, p = 0.001) without an increased risk of complications.
CONCLUSIONS: CNI maintenance for at least 12 months after KAF could be a useful approach to prevent high sensitization and reduce WL times in patients who are offered retransplantation, without a higher burden of complications.
摘要：
背景：广泛的国家或国际计划有助于减轻致敏患者的预期更长的等待名单（WL）时间，但对高度致敏受试者的益处较小。因此,迫切需要防止高度敏感的战略。在这项研究中,我们调查了同种异体肾移植失败(KAF)后接受不同免疫抑制(IS)处理的高致敏患者的风险.
方法：来自185例KAF患者的数据，从2010年到2020年，在意大利两个共享同一区域WL的地区重新移植/重新发行，进行了分析。在KAF后12个月，根据IS管理对患者进行如下分类：使用钙调磷酸酶抑制剂（CNI）维持IS的患者（晚期停药组[LWG]，n=58）和那些退出所有IS疗法或仅使用类固醇的人（早期退出组[EWG]，n=127）。
结果：LWG患者在12岁时显示较低的面板反应性抗体（PRA）（29.0％vs.85.5%,p<0.001）和24个月（61.0%与91.0%,p=0.001),12岁时高致敏风险降低（PRA≥90%）（9.4%vs.40.7%,p<0.001，OR=0.15）和24个月（25.6%vs.57.3%,p=0.001，OR=0.26），并且在12个月时几乎没有非常高的致敏性（PRA≥98％）（1.9％vs.18.6%,p=0.003,OR=0.08)KAF后。在LWG亚组分析中，KAF后维持IS长达24个月的患者没有表现出非常高的致敏作用.LWG显示活动WL时间较短（406与813天,p=0.001），没有增加并发症的风险。
结论：在接受再次移植的患者中，KAF后至少12个月的CNI维持可能是防止高致敏和减少WL时间的有用方法。没有更高的并发症负担。
方法：来自185例KAF患者的数据，从2010年到2020年，在意大利两个共享同一区域WL的地区重新移植/重新发行，进行了分析。在KAF后12个月，根据IS管理对患者进行如下分类：使用钙调磷酸酶抑制剂（CNI）维持IS的患者（晚期停药组[LWG]，n=58）和那些退出所有IS疗法或仅使用类固醇的人（早期退出组[EWG]，n=127）。
结果：LWG患者在12岁时显示较低的面板反应性抗体（PRA）（29.0％vs.85.5%,p<0.001）和24个月（61.0%与91.0%,p=0.001),12岁时高致敏风险降低（PRA≥90%）（9.4%vs.40.7%,p<0.001，OR=0.15）和24个月（25.6%vs.57.3%,p=0.001，OR=0.26），并且在12个月时几乎没有非常高的致敏性（PRA≥98％）（1.9％vs.18.6%,p=0.003,OR=0.08)KAF后。在LWG亚组分析中，KAF后维持IS长达24个月的患者没有表现出非常高的致敏作用.LWG显示活动WL时间较短（406与813天,p=0.001），没有增加并发症的风险。
结论：在接受再次移植的患者中，KAF后至少12个月的CNI维持可能是防止高致敏和减少WL时间的有用方法。没有更高的并发症负担。
