抗TNFα作为胰腺和脏移植的辅助疗法
Christophe Masset1,2, Benoit Mesnard1,2, Olivia Rousseau2
1Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France.
概括
使用Etanercept的辅助抗瘤坏死因子α (TNFα) 治疗对于胰腺移植接受者来说是安全的. 虽然它没有改善胰腺存活率,但它显著减少了排斥发作,而不会增加感染.
科学领域:
- 移植免疫学 移植免疫学
- 免疫抑制策略 免疫抑制策略
- 优化移植的生存率,优化移植的生存率.
背景情况:
- 胰腺全移植失败是一个重大的临床挑战,通常是由血栓形成和排斥驱动的.
- 目前的免疫抑制疗法需要优化,以减轻排斥严重程度并改善长期移植存活率.
- 抗瘤坏死因子α (TNFα) 治疗对胰腺移植结果的作用尚未得到充分证实.
研究的目的:
- 评估添加Etanercept,一种抗TNFα疗法,在胰腺移植中加入标准免疫抑制的安全性和有效性.
- 评估辅助抗TNFα治疗对胰腺异位移植存活率,排斥率和传染性并发症的影响.
- 为了确定抗TNFα治疗是否可以减少胰腺移植后排斥事件的发生率或严重性.
主要方法:
- 在2010年至2022年期间进行的236次胰腺移植的回顾性分析.
- 自2017年以来,接受标准免疫抑制治疗的患者和接受辅助Etanercept (抗TNFα疗法) 的患者之间的结局比较.
- 多变量分析以调整混变量并评估胰腺存活率,排斥期和传染性并发症 (细菌,真菌,CMV,BK病毒).
主要成果:
- 在Etanercept和未接受治疗组之间,胰腺存活率没有显著差异 (HR = 0.92,CI 95% = 0.48;1.73,p = 0.79).
- 在多变量分析中,辅助抗TNFα疗法 (Etanercept) 显著降低了胰腺排斥事件的发生率 (HR = 0.36,CI 95% = 0.14;0.95,p = 0.04).
- 与对照组相比,接受Etanercept的患者没有出现细菌,真菌,CMV或BK病毒感染的风险更高.
结论:
- 辅助抗TNFα治疗 (Etanercept) 对胰腺移植接受者来说是安全的,因为它不会增加感染性并发症.
- 尽管血栓形成率相似,但抗TNFα疗法显著减少胰腺排斥发作.
- 这些发现支持考虑抗TNFα疗法作为辅助治疗,以减轻胰腺移植接受者的排斥.
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