胰岛移植受者进行性肾或同种异体肾功能障碍患者保留或避免钙调磷酸酶抑制剂的维持免疫抑制。

IF 1.9 4区 医学 Q2 SURGERY
Jeanne M. Chen, Richard S. Mangus, Asif A. Sharfuddin, John A. Powelson, Muhammad S. Yaqub, Muhammad Y. Jan, Andrew J. Lutz, Jonathan A. Fridell
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引用次数: 0

摘要

Belatacept可用于替代或替代钙调磷酸酶抑制剂(CNI)以保持肾功能。胰腺移植(PTx)的使用受到胰腺排斥风险增加的限制。该回顾性分析包括2004年至2023年间进行的所有ptx。采用1:2的病例/对照分析来确定使用belatacept的预测因素,并比较同种异体移植物和患者生存率。在731例PTxs中,21例(3%)开始使用belatacept(8例胰腺和肾脏同时(SPK), 3例胰腺肾后(PAK), 10例胰腺移植(PTA)。1年后,Δ估计肾小球滤过率(eGFR)为+7% SPK, -15% PAK和+32% PTA。病例对照分析发现,除了接受PTA治疗的年龄较大外,没有人口统计学预测因素。与对照组相比,中位肾脏、胰腺或患者生存期均无差异。2例spk发生胰腺排斥反应。有两例胰腺移植失败死亡,均为PTAs。2例SPK和1例PAK移植失败。8名患者死亡。6人在死亡时仍在接受有功能的同种异体移植。在PTx后使用Belatacept是安全的,并且可以提供一些肾脏恢复。在eGFR接近20 mL/min/1.73m2时开始使用Belatacept。尽早引入可能会有更好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Belatacept Maintenance Immunosuppression for Calcineurin Inhibitor Sparing or Avoidance in Pancreas Transplant Recipients With Progressive Renal or Renal Allograft Dysfunction

Belatacept Maintenance Immunosuppression for Calcineurin Inhibitor Sparing or Avoidance in Pancreas Transplant Recipients With Progressive Renal or Renal Allograft Dysfunction

Belatacept may be used to spare or replace calcineurin inhibitors (CNI) to preserve renal function. Use in pancreas transplant (PTx) is limited by increased risk of pancreas rejection. This retrospective analysis included all PTxs performed between 2004 and 2023. A 1:2 case/control analysis was performed to identify predictors of belatacept use and compare allograft and patient survival. Of 731 PTxs, 21 (3%) started belatacept (eight simultaneous pancreas and kidney (SPK), three pancreas after kidney (PAK), and 10 pancreas transplant alone (PTA). At 1 year, Δ estimated glomerular filtration rate (eGFR) was +7% SPK, −15% PAK, and +32% PTA. Case–control analysis found no demographic predictors for belatacept except older recipient age for PTA. No difference in median kidney, pancreas, or patient survival was observed compared to control. Pancreas rejection occurred in two SPKs. There were two death censored pancreas allograft failures, both PTAs. Kidney allografts failed in two SPK and one PAK. Eight patients died. Six were still receiving belatacept at time of death with functioning allografts. Belatacept use after PTx is safe and can provide some renal recovery. Belatacept was initiated with eGFR approaching 20 mL/min/1.73m2. Earlier introduction may result in better outcomes.

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来源期刊
Clinical Transplantation
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.
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