Rita Leal, Pedro Fragoso, João Venda, José Gomes, Maria Inácio, Maria Guedes Marques, Luís Rodrigues, Lídia Santos, Catarina Romãozinho, Francisco Caramelo, Helena Oliveira Sá, António Martinho, Arnaldo Figueiredo, Rui Alves
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引用次数: 0
Abstract
Background: The optimal immunosuppressive (IS) withdrawal strategy after kidney allograft failure remains unclear. This study evaluated the effects of prolonged calcineurin inhibitor (CNI) therapy on HLA sensitization, graft intolerance syndrome (GIS), and key clinical outcomes.
Methods: We conducted a prospective cohort study involving 90 adult patients with kidney allograft failure who were candidates for re-transplantation. Patients were divided into two groups: Rapid withdrawal group (discontinuation of all IS except low-dose prednisolone) and Prolonged CNI Group (maintenance of CNI for six months plus low-dose prednisolone). Outcomes assessed over a 12-month follow-up period included HLA sensitization, defined as an increase in calculated panel reactive antibody (cPRA) and the development of de novo donor-specific antibodies (dnDSA), GIS incidence, re-transplantation, hospitalization rates, and mortality.
Results: No significant differences were observed between the groups regarding HLA sensitization one-year postgraft failure. A composite outcome of cPRA increase, dnDSA, and GIS did not differ between the groups. When evaluated separately, GIS occurred less frequently in the Prolonged CNI Group (4.8% vs. 23%; p = 0.015). Patients who continued CNI maintained better residual kidney function at 6 months (800 vs. 200 mL, p = 0.001) and experienced lower all-cause hospitalization rates (12% vs. 30%, p = 0.036), with comparable retransplantation and mortality rates. Graft removal and higher HLA mismatches were independently linked to increased sensitization at 12 months.
Conclusions: Prolonged CNI therapy for six months postallograft loss did not prevent HLA sensitization but reduced the incidence of GIS and preserved residual kidney function without increasing hospitalization or mortality.
背景:同种异体肾移植失败后最佳的免疫抑制剂(IS)停药策略尚不清楚。本研究评估了延长钙调磷酸酶抑制剂(CNI)治疗对HLA致敏、移植物不耐受综合征(GIS)和主要临床结局的影响。方法:我们进行了一项前瞻性队列研究,涉及90名成年肾移植衰竭患者,他们是再次移植的候选人。患者分为两组:快速停药组(停止除低剂量强的松龙外的所有IS)和延长CNI组(维持CNI 6个月+低剂量强的松龙)。在12个月的随访期间评估的结果包括HLA致敏,定义为计算的面板反应性抗体(cPRA)的增加和新生供体特异性抗体(dnDSA)的发展,GIS发病率,再移植,住院率和死亡率。结果:移植失败后1年各组间HLA致敏性无显著差异。cPRA增加、dnDSA和GIS的综合结果在两组之间没有差异。当单独评估时,GIS在延长的CNI组中发生的频率较低(4.8%对23%;p = 0.015)。继续CNI的患者在6个月时保持了更好的残余肾功能(800 mL vs 200 mL, p = 0.001),全因住院率较低(12% vs 30%, p = 0.036),再移植和死亡率相当。在12个月时,移植物切除和更高的HLA错配与敏感性增加独立相关。结论:同种异体移植物丢失后延长CNI治疗6个月不能阻止HLA致敏,但可以降低GIS的发生率和保留残余肾功能,而不会增加住院率和死亡率。
期刊介绍:
Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.