Säemann Marcus D, Sunder-Plassmann Gere
Department of Medicine III, Medical University of Vienna, Austria.
Transpl Immunol. 2008 Nov;20(1-2):14-20. doi: 10.1016/j.trim.2008.08.012. Epub 2008 Sep 18.
In the present study we have analyzed the maintenance immunosuppression of renal transplant patients followed at the Medical University of Vienna. Since more than thousand renal transplant patients are registered and treated at this center, our data reveal the pattern as well as the current and past practices of the prescription of immunosuppressive drugs in a large outpatient setting. The majority of patients displayed a transplant vintage of more than 5 years and used calcineurin inhibitors (CNIs), and/or steroids and/or antimetabolites reflecting the general prescription profile of immunosuppressive drugs in renal transplant recipients. However, the selection of immunosuppressive combinations as well as the dynamics of the immunosuppressive regimen in the life of the stable allograft recipient - minimization, conversion and/or withdrawal of one or more of each of the drugs - are not founded on strong data derived from adequately powered clinical trials but rather follows a mixture of various smaller and medium-sized clinical studies and the individual center attitude based on mostly center-specific uncontrolled clinical observations. Hence, the maintenance immunosuppression of transplant patients is the result of a strong empirical attitude and only adequately powered prospective trials may inform us which immunosuppressive regimen and overall strategy will be ideal for the individual renal transplant recipient.
在本研究中，我们分析了维也纳医科大学随访的肾移植患者的维持性免疫抑制情况。由于该中心登记并治疗了超过一千名肾移植患者，我们的数据揭示了在大型门诊环境中免疫抑制药物处方的模式以及当前和过去的做法。大多数患者的移植时间超过5年，使用钙调神经磷酸酶抑制剂（CNIs）和/或类固醇和/或抗代谢物，这反映了肾移植受者免疫抑制药物的一般处方情况。然而，免疫抑制组合的选择以及稳定同种异体移植受者生命中免疫抑制方案的动态变化——一种或多种药物的最小化、转换和/或停用——并非基于来自充分有力的临床试验的可靠数据，而是遵循各种中小型临床研究的混合以及基于大多是中心特定的非对照临床观察的个体中心态度。因此，移植患者的维持性免疫抑制是强烈经验主义态度的结果，只有充分有力的前瞻性试验才能告诉我们哪种免疫抑制方案和总体策略对个体肾移植受者是理想的。
