移植后免疫抑制疗法的比较安全性和有效性:系统性审查
Shahid Qayyum1, Kamran Shahid2
1Nephrology, Diaverum Dialysis Center, Wadi Al Dawasir, SAU.
Cureus
|September 25, 2023
概括
对于接受脏移植的人来说,每天服用一次塔克罗利与mTOR抑制剂相结合,提供了一个可行的免疫抑制选择. 与其他策略相比,这种疗法可以减少副作用,同时保持有效性.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 接受脏移植的人通常使用塔克罗利,这是一种免疫抑制剂,具有显著的副作用,如新发糖尿病和毒性.
- 替代性免疫抑制剂包括哺乳动物目标拉巴胺素 (mTOR) 抑制剂,贝拉塔塞普特和布莱塞卢马布正在探索以减轻氨酸抑制剂毒性.
研究的目的:
- 系统地审查随机对照试验,比较不同免疫抑制疗法的安全性和有效性.
- 确定最佳的免疫抑制策略,以平衡移植保护与减少不良事件.
主要方法:
- 在PubMed,Cochrane图书馆和Mendeley进行了系统的文献搜索.
- 包括的研究是遵守PRISMA 2020指南的随机对照试验,比较不同的免疫抑制药物组合和剂量频率.
主要成果:
- 在每天一次和每天两次的塔克罗利莫斯剂量之间没有观察到安全性或疗效的显著差异.
- 拉巴胺素 (mTOR) 抑制剂的哺乳动物标是减少氨酸抑制剂暴露的可行选择.
- 涉及避开氨酸抑制剂或早期戒除类固醇的疗法与更高的排斥率有关.
结论:
- 每天服用一次塔克罗利和mTOR抑制剂的组合,带有或没有皮质类固醇,代表了移植后的一个有前途的免疫抑制策略.
- 进一步的长期研究是有必要的,以充分阐明这些优化方案的安全性和有效性.
相关概念视频
01:28Kidney Transplant I: Introduction
14
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
14
01:26Kidney Transplant II: Surgical Procedure
22
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
22
01:16Kidney Transplant III: Nursing Management
23
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
23
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
21
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
21
01:22Acute Kidney Injury I: Introduction
15
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
15
01:29Acute Kidney Injury III: Clinical Manifestations
15
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
15