在成年活着的捐赠者肝脏移植后避免使用类固醇:一个队列分析
Miguel Nunez1, Claudia R Praglin2, Ana M Torres2
1School of Medicine, University of California San Francisco, San Francisco, CA.
Transplantation direct
|May 30, 2023
概括
活体供体肝移植 (LDLT) 中的类固醇避免 (SA) 与类固醇维持 (SM) 相比,显示出类似的早期急性排斥率和患者存活率. 这种方法对LDLT接受者,包括那些患有自身免疫疾病的人来说是安全的.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 免疫学 免疫学 免疫学
背景情况:
- 在已故捐赠者的肝移植中,已经确立了类固醇避免 (SA),但在活体捐赠者的肝移植中 (LDLT) 了解较少.
- 研究LDLT中的SA对于优化移植后免疫抑制和患者结果至关重要.
研究的目的:
- 为了比较早期急性排斥 (AR) 和LDLT接受者在SA和常规类固醇维护 (SM) 之间的并发症发生率.
- 在两个不同的LDLT队列中评估患者存活率和AR风险因素.
主要方法:
- 一个单一中心的回顾性队列研究比较了242名LDLT接受者与SM (2000-2017) 和83名LDLT接受者与SA (2017-2021).
- 早期AR被定义为在移植后6个月内通过活检证明的排斥.
- 使用后勤回归分析来确定AR的风险因素.
主要成果:
- 在SA (22.9%) 和SM (17%) 队列之间,早期AR率没有统计学上显著的差异 (P=0.46).
- 受益人年龄被确定为早期AR的显著风险因素 (P<0.001).
- 3年后患者的存活率相似:SA的94%,SM的91% (P=0.34).
结论:
- 与维护类固醇相比,在LDLT中避开类固醇并不会增加排斥或死亡的风险.
- SA是对LDLT的可行的策略,即使在患有自身免疫疾病的患者中也是如此.
- 接受者的年龄是影响LDLT的AR风险的一个关键因素.
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