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贝拉塔塞普特使用和衰老对移植后感染和死亡并发症的作用
Hareesh Singam1, Abdinoor Abdi2, Wyatt Tarter3
1Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
概括
在移植接受者中,贝拉塔塞普的使用增加了埃普斯坦-巴尔病毒 (EBV) 和细胞巨血病毒 (CMV) 感染和移植失败的风险. 老年患者 (≥55岁) 需要仔细考虑贝拉塔塞普治疗,因为死亡风险较高.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植免疫学 移植免疫学
- 传染性疾病 传染性疾病
背景情况:
- 在使用贝拉塔塞普特与氨酸抑制剂或抗代谢剂相比,存在关于移植 (KT) 后感染率的相互矛盾的数据.
- 这项研究旨在澄清接受贝拉塔塞普的KT接受者与不接受贝拉塔塞普的接受者之间的传染性结果.
研究的目的:
- 在移植接受者中,比较belatacept使用者和非使用者之间的感染结果.
- 为了确定与特定感染和移植后不良事件相关的风险因素.
主要方法:
- 一项回顾性研究包括从2018年1月1日到2022年12月31日的初级KT患者.
- 考克斯比例危险模型被采用,将贝拉塔塞普的使用视为时间变化的协变量,并根据多个患者和移植因素进行调整.
- 安德森-吉尔危险模型专门研究了DNAemia的复发.
主要成果:
- 贝拉塔塞普的使用与埃普斯坦-巴尔病毒 (EBV) 和细胞巨乳病毒 (CMV) 初次感染的风险显著增加有关.
- 在belatacept接受者中,还观察到异种移植失败和急性细胞排斥的风险增加.
- 老年 (每年增加) 和D+/R-CMV血清状况被确定为EBV和CMV感染的独立风险因素.
结论:
- 在移植接受者中,贝拉塔塞普的使用与EBV和CMV感染,移植失败和急性细胞排斥的风险增加有关.
- 仔细选择患者接受贝拉塔塞普是至关重要的,特别是对于年长的接受者 (≥55岁),由于死亡率和病毒性DNAemia的风险增加.
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