Chang Sean H, Russ Graeme R, Chadban Steven J, Campbell Scott, McDonald Stephen P
Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Queen Elizabeth Hospital, Woodville South, SA 5011, Australia.
Nephrology (Carlton). 2008 Apr;13(2):171-6. doi: 10.1111/j.1440-1797.2007.00859.x.
Kidney transplant outcomes have improved over the past 15 years, partly due to improvements in immunosuppression. We used data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry to examine trends in immunosuppressive use post transplant.
All adult (recipient age 16+ years) kidney-only transplants performed in Australia from April 1991 to December 2005 were followed to graft loss or December 2005. Immunosuppressive use at induction, 1, 3 and 5 years post transplant were analysed by transplant cohort.
Calcineurin-inhibitors (CNI) were used in most recipients for induction and maintenance immunosuppression, with increasing tacrolimus use. Induction cyclosporin dose increased since 2001 (from 5.8 to 7.9 mg/kg per day), but maintenance cyclosporin and tacrolimus dose decreased (from 3.8 to 3.0 mg/kg per day cyclosporin at 1 year post transplant). CNI-free induction increased since 2002 (from 1.4% to 8.4%), while CNI-free maintenance increased throughout the study period. Mycophenolates were the predominant antimetabolite used. Steroid-free maintenance decreased (from 22.7% to 8.7% at 1 year post transplant), as did median prednisolone doses (from 0.12 to 0.09 mg/kg per day at 1 year post transplant). Sirolimus or everolimus are increasingly used for CNI-sparing rather than as antimetabolites substitutes. OKT3 or antithymocyte globulin induction decreased, while anti-CD25 antibody usage increased from 9.5% to 57.1% since 2000.
There is a trend to more potent induction immunosuppression with tacrolimus, mycophenolates and anti-CD-25 antibodies, but with CNI avoidance or minimization during maintenance phase. While steroid avoidance/cessation decreased, maintenance steroid dose has also decreased. Anti-CD25 antibodies are now used in >50% of recipients.
在过去15年中，肾移植的结果有所改善，部分原因是免疫抑制方面的改进。我们使用来自澳大利亚和新西兰透析与移植（ANZDATA）登记处的数据，来研究移植后免疫抑制药物使用的趋势。
对1991年4月至2005年12月在澳大利亚进行的所有成人（受者年龄16岁及以上）单纯肾移植进行随访，直至移植肾失功或到2005年12月。按移植队列分析移植后诱导期、1年、3年和5年时免疫抑制药物的使用情况。
大多数受者在诱导和维持免疫抑制时使用钙调神经磷酸酶抑制剂（CNI），他克莫司的使用有所增加。自2001年以来，诱导期环孢素剂量增加（从每天5.8毫克/千克增至7.9毫克/千克），但维持期环孢素和他克莫司剂量减少（移植后1年时，环孢素从每天3.8毫克/千克降至3.0毫克/千克）。自2002年以来，无CNI诱导增加（从1.4%增至8.4%），而在整个研究期间无CNI维持也有所增加。霉酚酸酯是使用的主要抗代谢药物。无类固醇维持减少（移植后1年时从22.7%降至8.7%），泼尼松龙中位剂量也减少（移植后1年时从每天0.12毫克/千克降至0.09毫克/千克）。西罗莫司或依维莫司越来越多地用于减少CNI使用，而非作为抗代谢药物替代物。OKT3或抗胸腺细胞球蛋白诱导减少，而自2000年以来抗CD25抗体的使用从9.5%增至57.1%。
存在一种趋势，即使用他克莫司、霉酚酸酯和抗CD - 25抗体进行更强效的诱导免疫抑制，但在维持期避免或尽量减少CNI使用。虽然避免/停用类固醇减少，但维持期类固醇剂量也有所减少。现在超过50%的受者使用抗CD25抗体。
