在接受阿勒姆图祖马布诱导治疗的高度敏感患者中,维护类固醇节约免疫抑制
Eva Santos1, Katrina Spensley2,3, Nicola Gunby1
1Histocompatibility and Immunogenetics Laboratory, Northwest London Pathology NHS Trust, Hammersmith Hospital, London, United Kingdom.
概括
对于接受脏移植的高度敏感的患者,联合塔克罗利和mycophenolate mofetil (FK + MMF) 的维持免疫抑制策略,与塔克罗利单独治疗 (FK) 相比,显示出更高的无排斥生存率. 这种类固醇节约的方法对管理这些复杂的患者群体有希望.
科学领域:
- 腎病學和免疫學 腎病學和免疫學
- 移植医学 移植医学 移植医学
- 免疫抑制协议 免疫抑制协议
背景情况:
- 高度敏感的患者 (HSPs) 在移植中存在独特的挑战,原因是预先形成的抗体和更高的排斥风险.
- 节制类固醇的免疫抑制方案越来越多地被寻求,以尽量减少移植受体的长期副作用.
- 在Alemtuzumab诱导之后,不同的维护方案需要进行研究,以获得HSP的最佳结果.
研究的目的:
- 在高度敏感的脏移植接受者中比较两种类固醇节约免疫抑制方案的疗效和安全性.
- 评估患者的一年和全移植存活率,无排斥存活率和特定并发症率 (DSA,BK病毒,CMV,移植后糖尿病).
主要方法:
- 对120名高度敏感的患者 (cRF>85%) 的回顾性分析,这些患者接受了用Alemtuzumab诱导进行移植.
- 患者被分为两个维护免疫抑制组:单独治疗的塔克罗利 (FK,n=53) 和塔克罗利加上mycophenolate mofetil (FK + MMF,n=67).
- 结果包括患者/异构移植存活率,无排斥存活率,无DSA存活率以及BK,CMV和移植后糖尿病的发病率.
主要成果:
- 在FK和FK + MMF组之间,患者或异种移植存活时间在一年内没有显著差异.
- 与FK组 (65.4%) 相比,FK+MMF组的无排斥生存率 (91.4%) 显著高于FK组 (p < 0.01).
- FK + MMF组的CMV无生存率较低 (86.0%对98.1%,p = 0.026),而FK组的移植后糖尿病率较高 (p = 0.027),与预尼索隆用于排斥有关.
结论:
- 随着Alemtuzumab诱导和FK+MMF维护的类固醇节约方案在高度敏感的脏移植接受者中显示出出色的结果,特别是在排斥预防方面.
- 虽然FK + MMF提供了改善的无排斥生存率,但需要仔细监测细胞巨血病毒 (CMV) 感染.
- 这项研究支持使用FK+MMF作为HSP的有效维护策略,有助于避免移植时使用类固醇.
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