背景:肾移植失败(KAF)后免疫抑制治疗(IT)的最佳管理仍存在争议。虽然维持IT可以减少HLA致敏并改善再次移植的机会,它还可能增加免疫抑制相关并发症的发生率。对患者死亡率的总体影响尚不清楚。这项研究的主要目的是根据IT管理比较KAF后6个月HLA致敏的演变。
方法:从法国国家终末期肾脏疾病登记处(肾脏流行病学和信息网络[REIN])和法国国家健康数据系统(SNDS)中提取个人临床和医疗保健数据,分别。包括2008年1月至2019年12月在洛林的KAF后恢复透析的年龄>18岁的患者。患者分为两组,IT延续或IT终止。HLA致敏被定义为KAF和KAF后6个月之间的不相容移植率(IGR)增加(更改为更高的预定义类别(0%-5%),(5%-20%),(20%-50%),(50%-85%),(85%-95%),(95%-98%),(98%-100%))。次要结果是根据IT管理的患者生存率。
结果:共纳入121例患者,其中35人(29%)继续使用IT。在“IT停药”组中,KAF后的HLA致敏倾向于更高(57%与38%的人在“IT延续”组中,p=.07)。在多变量分析中,IT延续与IGR较低的增加相关(OR.37,95%CI[.14;.93])。IT管理与患者死亡率无关。
结论:KAF后IT的延续与IGR变化较小相关,与超额死亡率无关。
The optimal management of immunosuppressive therapy (IT) after kidney allograft failure (KAF) remains controversial. Although maintaining IT may reduce HLA-sensitization and improve access to retransplantation, it may also increase the rate of immunosuppression-related complications. The overall impact on patient mortality is unknown. The main objective of this study was to compare the evolution of HLA-sensitization 6 months after KAF according to IT management.
Individual clinical and health care data were extracted from the French national end-stage kidney disease registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Patients aged > 18 years returning to dialysis after KAF between January 2008 and December 2019 in Lorraine were included. Patients were classified into two groups, IT continuation or IT discontinuation. HLA-sensitization was defined as an increase in incompatible graft rate (IGR) between KAF and 6 months post-KAF (change to a higher predefined category (0%-5%), (5%-20%), (20%-50%), (50%-85%), (85%-95%), (95%-98%), (98%-100%)). Secondary outcome was patient survival according to IT management.
A total of 121 patients were included, 35 (29%) of whom continued IT. HLA-sensitization after KAF tended to be higher in the \"IT discontinuation\" group (57% vs. 38% in the \"IT continuation\" group, p = .07). In multivariate analysis, IT continuation was associated with a lower increase in IGR (OR .37, 95% CI [.14; .93]). IT management was not associated with patient mortality.
Continuation of IT after KAF was associated with less change in IGR and was not associated with excess mortality.