PDF(Pubmed)
Abstract：
UNASSIGNED: Tacrolimus has been associated with recurrence of primary biliary cholangitis (PBC) after liver transplantation (LT), which in turn may reduce survival. This study aimed to assess the association between the type of calcineurin inhibitor used and long-term outcomes following LT in patients with PBC.
UNASSIGNED: Survival analyses were used to assess the association between immunosuppressive drugs and graft or patient survival among adult patients with PBC in the European Liver Transplant Registry. Patients who received a donation after brain death graft between 1990 and 2021 with at least 1 year of event-free follow-up were included.
UNASSIGNED: In total, 3,175 patients with PBC were followed for a median duration of 11.4 years (IQR 5.9-17.9) after LT. Tacrolimus (Tac) was registered in 2,056 (64.8%) and cyclosporin in 819 (25.8%) patients. Following adjustment for recipient age, recipient sex, donor age, and year of LT, Tac was not associated with higher risk of graft loss (adjusted hazard ratio [aHR] 1.07, 95% CI 0.92-1.25, p = 0.402) or death (aHR 1.06, 95% CI 0.90-1.24, p = 0.473) over cyclosporin. In this model, maintenance mycophenolate mofetil (MMF) was associated with a lower risk of graft loss (aHR 0.72, 95% CI 0.60-0.87, p <0.001) or death (aHR 0.72, 95% CI 0.59-0.87, p <0.001), while these risks were higher with use of steroids (aHR 1.31, 95% CI 1.13-1.52, p <0.001, and aHR 1.34, 95% CI 1.15-1.56, p <0.001, respectively).
UNASSIGNED: In this large LT registry, type of calcineurin inhibitor was not associated with long-term graft or recipient survival, providing reassurance regarding the use of Tac post LT in the population with PBC. Patients using MMF had a lower risk of graft loss and death, indicating that the threshold for combination treatment with Tac and MMF should be low.
UNASSIGNED: This study investigated the association between immunosuppressive drugs and the long-term survival of patients with primary biliary cholangitis (PBC) following donation after brain death liver transplantation. While tacrolimus has previously been related to a higher risk of PBC recurrence, the type of calcineurin inhibitor was not related to graft or patient survival among patients transplanted for PBC in the European Liver Transplant Registry. Additionally, maintenance use of mycophenolate was linked to lower risks of graft loss and death, while these risks were higher with maintenance use of steroids. Our findings should provide reassurance for physicians regarding the continued use of Tac after liver transplantation in the population with PBC, and suggest potential benefit from combination therapy with mycophenolate.
UNASSIGNED: Survival analyses were used to assess the association between immunosuppressive drugs and graft or patient survival among adult patients with PBC in the European Liver Transplant Registry. Patients who received a donation after brain death graft between 1990 and 2021 with at least 1 year of event-free follow-up were included.
UNASSIGNED: In total, 3,175 patients with PBC were followed for a median duration of 11.4 years (IQR 5.9-17.9) after LT. Tacrolimus (Tac) was registered in 2,056 (64.8%) and cyclosporin in 819 (25.8%) patients. Following adjustment for recipient age, recipient sex, donor age, and year of LT, Tac was not associated with higher risk of graft loss (adjusted hazard ratio [aHR] 1.07, 95% CI 0.92-1.25, p = 0.402) or death (aHR 1.06, 95% CI 0.90-1.24, p = 0.473) over cyclosporin. In this model, maintenance mycophenolate mofetil (MMF) was associated with a lower risk of graft loss (aHR 0.72, 95% CI 0.60-0.87, p <0.001) or death (aHR 0.72, 95% CI 0.59-0.87, p <0.001), while these risks were higher with use of steroids (aHR 1.31, 95% CI 1.13-1.52, p <0.001, and aHR 1.34, 95% CI 1.15-1.56, p <0.001, respectively).
UNASSIGNED: In this large LT registry, type of calcineurin inhibitor was not associated with long-term graft or recipient survival, providing reassurance regarding the use of Tac post LT in the population with PBC. Patients using MMF had a lower risk of graft loss and death, indicating that the threshold for combination treatment with Tac and MMF should be low.
UNASSIGNED: This study investigated the association between immunosuppressive drugs and the long-term survival of patients with primary biliary cholangitis (PBC) following donation after brain death liver transplantation. While tacrolimus has previously been related to a higher risk of PBC recurrence, the type of calcineurin inhibitor was not related to graft or patient survival among patients transplanted for PBC in the European Liver Transplant Registry. Additionally, maintenance use of mycophenolate was linked to lower risks of graft loss and death, while these risks were higher with maintenance use of steroids. Our findings should provide reassurance for physicians regarding the continued use of Tac after liver transplantation in the population with PBC, and suggest potential benefit from combination therapy with mycophenolate.
摘要：
■他克莫司与肝移植（LT）后原发性胆汁性胆管炎（PBC）的复发有关，这反过来可能会降低生存率。本研究旨在评估PBC患者使用的钙调磷酸酶抑制剂类型与LT后长期结局之间的关系。
■生存分析用于评估在欧洲肝移植注册中的PBC成年患者中免疫抑制药物与移植物或患者生存之间的关联。纳入了在1990年至2021年之间接受脑死亡移植后捐赠的患者，并进行了至少1年的无事件随访。
■总共，随访3,175例PBC患者，随访时间中位数为11.4年（IQR5.9-17.9）。他克莫司（Tac）在2,056例（64.8％）中注册，环孢菌素在819例（25.8％）中注册。在调整收件人年龄后，接受者性别,供体年龄,和LT年，与环孢菌素相比，Tac与移植物丢失（校正风险比[aHR]1.07，95％CI0.92-1.25，p=0.402）或死亡（aHR1.06，95％CI0.90-1.24，p=0.473）的风险无关。在这个模型中,维持霉酚酸酯（MMF）与移植物丢失（aHR0.72，95％CI0.60-0.87，p<0.001）或死亡（aHR0.72，95％CI0.59-0.87，p<0.001）的风险较低有关，而使用类固醇的风险更高(分别为aHR1.31,95%CI1.13-1.52,p<0.001,和aHR1.34,95%CI1.15-1.56,p<0.001).
■在这个大型LT注册表中，钙调磷酸酶抑制剂的类型与移植物或受体的长期存活无关，提供关于在PBC人群中使用TacpostLT的保证。使用MMF的患者移植物丢失和死亡的风险较低，这表明Tac和MMF联合治疗的阈值应该很低。
■这项研究调查了免疫抑制药物与原发性胆汁性胆管炎（PBC）患者在脑死亡肝移植后捐献后长期生存之间的关系。虽然他克莫司以前与PBC复发的风险较高有关，在欧洲肝移植登记处,在接受PBC移植的患者中,钙调神经磷酸酶抑制剂的类型与移植物或患者存活无关.此外,霉酚酸酯的维持使用与降低移植物丢失和死亡的风险有关，而维持使用类固醇的风险更高。我们的发现应该为PBC患者肝移植后继续使用Tac的医生提供保证，并提示与霉酚酸酯联合治疗的潜在益处。
■生存分析用于评估在欧洲肝移植注册中的PBC成年患者中免疫抑制药物与移植物或患者生存之间的关联。纳入了在1990年至2021年之间接受脑死亡移植后捐赠的患者，并进行了至少1年的无事件随访。
■总共，随访3,175例PBC患者，随访时间中位数为11.4年（IQR5.9-17.9）。他克莫司（Tac）在2,056例（64.8％）中注册，环孢菌素在819例（25.8％）中注册。在调整收件人年龄后，接受者性别,供体年龄,和LT年，与环孢菌素相比，Tac与移植物丢失（校正风险比[aHR]1.07，95％CI0.92-1.25，p=0.402）或死亡（aHR1.06，95％CI0.90-1.24，p=0.473）的风险无关。在这个模型中,维持霉酚酸酯（MMF）与移植物丢失（aHR0.72，95％CI0.60-0.87，p<0.001）或死亡（aHR0.72，95％CI0.59-0.87，p<0.001）的风险较低有关，而使用类固醇的风险更高(分别为aHR1.31,95%CI1.13-1.52,p<0.001,和aHR1.34,95%CI1.15-1.56,p<0.001).
■在这个大型LT注册表中，钙调磷酸酶抑制剂的类型与移植物或受体的长期存活无关，提供关于在PBC人群中使用TacpostLT的保证。使用MMF的患者移植物丢失和死亡的风险较低，这表明Tac和MMF联合治疗的阈值应该很低。
■这项研究调查了免疫抑制药物与原发性胆汁性胆管炎（PBC）患者在脑死亡肝移植后捐献后长期生存之间的关系。虽然他克莫司以前与PBC复发的风险较高有关，在欧洲肝移植登记处,在接受PBC移植的患者中,钙调神经磷酸酶抑制剂的类型与移植物或患者存活无关.此外,霉酚酸酯的维持使用与降低移植物丢失和死亡的风险有关，而维持使用类固醇的风险更高。我们的发现应该为PBC患者肝移植后继续使用Tac的医生提供保证，并提示与霉酚酸酯联合治疗的潜在益处。
