年长的移植患者使用标准协议过度免疫抑制,有不同的基于性别的并发症
Inji Alshaer1, Rachel K Y Hung1, Sumoyee Basu1
1UCL Centre for Kidney and Bladder Health, Royal Free Hospital, London, UK.
Journal of transplantation
|October 23, 2025
概括
年龄较大的移植接受者面临更高的风险细胞巨乳病毒 (CMV) 病毒和恶性瘤由于与年龄相关的免疫抑制 (IS) 脆弱性. 这些发现凸显了移植协议中需要针对年龄和性别进行特定的IS调整的需要.
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
- 移植医学 移植医学
背景情况:
- 移植越来越多地在老年人中进行.
- 现有证据表明,年龄和性别影响免疫反应和与免疫抑制 (IS) 相关的风险.
- 目前的协议很少包含特定于年龄或性别的IS调整.
研究的目的:
- 为了研究年长的接受者 (>60岁) 移植的结果.
- 为了比较不同年龄层中年长和年轻的接受者之间的结果.
- 在移植接受者中识别与IS协议相关的特定年龄和性别风险.
主要方法:
- 追溯分析了148例接受60岁以上的接受者和272名年轻的接受者 (18-60岁) 的移植.
- 匹配标准包括人类白细胞抗原 (HLA) 敏感性,HLA不匹配,以及细胞巨核病毒 (CMV) 血清状态.
- 评估结果:活检证明的急性排斥 (BPAR),CMV病毒性病,新发性恶性瘤和供体特异性抗HLA抗体 (DSA).
主要成果:
- 活检证明的急性排斥 (BPAR) 率在35岁以下的接受者中最高;在老年人群中没有显著差异.
- 较年长的接受者 (> 60岁) 与最年轻的组相比,具有显著更高的CMV病毒性血清 (HR:2.66) 和恶性瘤 (HR:7.3) 的风险.
- 老年女性的CMV感染风险最高,而老年男性的恶性瘤风险最大;所有年龄组的捐赠者特异性抗HLA抗体 (DSAs) 发生率相似.
结论:
- 接受者年龄较大与对CMV病毒病和脏移植后恶性瘤的脆弱性增加有关.
- 在老年女性 (CMV) 和老年男性 (恶性病) 中观察到特定风险.
- 这些发现强调了为接受移植的接受者制定适合年龄和性别的免疫抑制方案的必要性.
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