降低早期亚治疗性他克莫司波谷对接受兔抗胸腺细胞球蛋白诱导的中低风险肾移植受者短期预后的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-15 DOI:10.1111/ctr.70156

Xinqi Liu, Jennifer Trofe-Clark, Deirdre Sawinski, Brendan Steiner, Shahreen Sharma, Stephanie Witek, Tara Fallah, Maxwell Norris, Chelsea Sammons, Gregory Malat

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引用次数: 0

摘要

采用亚治疗性他克莫司槽的肾移植（KTx）受者预后较差。目前尚不清楚兔抗胸腺细胞球蛋白（rATG）诱导是否会延迟早期亚治疗性他克莫司波谷的有害影响。该研究的目的是比较在出院时使用他克莫司槽分层的KTx受者的短期移植结果。方法单中心回顾性队列研究比较成人KTx受体亚治疗性和治疗性他克莫司释放谷(定义为<；vs.≥8 ng/mL)。纳入2017年10月至2019年12月期间接受rATG诱导和他克莫司免疫抑制且住院时间≤5天的原发性/继发性KTx成功患者。主要综合结果分析了3个月排斥反应、移植物损失或新生供体特异性抗体（dnDSA）的风险。Cox回归分析评估了早期亚治疗性他克莫司波谷与短期移植结果的关系。结果纳入的411例患者中，335例（81.5%）出院时他克莫司浓度≥8ng /mL， 76例（18%）出院时他克莫司浓度≥8ng /mL。我们的人群包括30%的黑人/非西班牙裔，10%的既往KTx病史，60%的已故献血者，低cPRA（中位数为0%），处于低免疫风险范围。主要结局无显著差异（13.4%比9.2%,p = 0.44）。Cox回归分析发现出院时亚治疗性他克莫司波谷与主要结局无关联。结论接受rATG诱导的KTx受体，亚治疗性他克莫司槽（< 8ng /mL）出院与治疗性槽（≥8ng /mL）出院的短期移植结果相当。这表明延迟放电达到治疗低谷是没有必要的。

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Decreasing the Risk of Early Sub-Therapeutic Tacrolimus Troughs on Short-Term Outcomes in Low-Moderate Risk Kidney Transplant Recipients Receiving Rabbit Anti-Thymocyte Globulin Induction

Introduction

Outcomes are poor in kidney transplant (KTx) recipients with sub-therapeutic tacrolimus troughs. It is unknown if rabbit anti-thymocyte globulin (rATG) induction delays the deleterious impact of early sub-therapeutic tacrolimus troughs. The study aims compared short-term graft outcomes of KTx recipients stratified by tacrolimus troughs at the time of discharge from index admission.

Methods

Single-center retrospective cohort study compared adult KTx recipients with sub-therapeutic versus therapeutic discharge tacrolimus troughs (defined as < vs. ≥ 8 ng/mL). Successful primary/secondary KTx between 10/2017 and 12/2019, who received rATG induction and tacrolimus-based immunosuppression and had an index admission length of stay ≤5 days were included. The primary composite outcome analyzed the 3-month risk of rejection, graft loss, or de novo donor-specific antibodies (dnDSA). Cox regression analysis assessed the association of early sub-therapeutic tacrolimus troughs on short-term graft outcomes.

Results

Among 411 recipients included, 335 (81.5%) were discharged with a tacrolimus trough <8 ng/mL versus 76 (18%) ≥8 ng/mL. Our population consisted of 30% black/non-Hispanic, 10% with a history of previous KTx, 60% deceased donors, and low cPRA (median 0%), which was in the low immunological risk range. No significant difference was identified in the primary outcome (13.4% vs. 9.2%, p = 0.44). Cox regression analysis identified no association between sub-therapeutic tacrolimus troughs at discharge and the primary outcome.

Conclusion

KTx recipients receiving rATG induction, discharged with sub-therapeutic tacrolimus troughs (<8 ng/mL) have comparable short-term graft outcomes versus those discharged with therapeutic troughs (≥8 ng/mL). This suggests that delaying discharge to reach therapeutic troughs is not necessary.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.