关于对敏感移植患者的管理的欧洲共识:德尔菲研究
Lucrezia Furian1, Oriol Bestard2, Klemens Budde3
1Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy.
概括
对于移植接受者,ENGAGE倡议建立了对敏感患者脱敏和免疫调节策略的共识,旨在减少抗体介导排斥并改善结果.
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
- 移植 移植 移植 移植
背景情况:
- 等待移植的敏感患者面临着有限的选择和高死亡率.
- 抗体中介排斥 (AMR),由捐赠者特异性抗体 (DSA) 触发,是这些患者移植失败的主要原因.
- 欧洲器官移植学会 (ESOT) 发起了ENGAGE计划,以解决对敏感器官移植候选人的护理缺口.
研究的目的:
- 为对敏感移植候选人的管理制定基于共识的建议.
- 根据AMR风险对患者进行分类,以指导治疗策略.
- 评估当前的脱敏和免疫调节方案.
主要方法:
- 进行了诱导和维护方案以及抗体去除策略的系统审查.
- 采用了Delphi方法论,包括对53名欧洲专家分发的利克特尺度调查.
- 共识被定义为至少75%的参与者之间的协议.
主要成果:
- 在95.3%的评估陈述中,就对敏感移植接受者的护理达成共识.
- 大多数建议在专家之间一致,这表明对当前做法存在普遍共识.
- 关于关于用于AMR预防的补充抑制剂使用的两个具体陈述,观察到缺乏共识.
结论:
- "ENGAGE共识"提供了当代的风险分层建议,用于敏感移植受体的脱敏和免疫调节.
- 实施量身定制的,针对患者的具体策略预计将优化护理并改善移植可访问性.
- 需要进行进一步的专门研究,以评估这些拟议方法在改善移植结果方面的长期疗效.
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