Luan F L, Steffick D E, Gadegbeku C, Norman S P, Wolfe R, Ojo A O
Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA.
Am J Transplant. 2009 Jan;9(1):160-8. doi: 10.1111/j.1600-6143.2008.02442.x. Epub 2008 Oct 24.
Steroid-free regimen is increasingly employed in kidney transplant recipients across transplant centers. However, concern remains because of the unknown impact of such an approach on long-term graft and patient survival. We studied the outcomes of steroid-free immunosuppression in a population-based U.S. cohort of kidney transplant recipients. All adult solitary kidney transplant recipients engrafted between January 1, 2000 and December 31, 2006 were stratified according to whether they were selected for a steroid-free or steroid-containing regimen at discharge. Multivariate Cox regression models were used to estimate graft and patient survival. The impact of the practice pattern on steroid use at individual transplant centers was analyzed. Among 95 755 kidney transplant recipients, 17.2% were steroid-free at discharge (n = 16 491). Selection for a steroid-free regimen was associated with reduced risks for graft failure and death at 1 year (HR 0.78, 95% CI 0.72-0.85, and HR 0.73, 95% CI 0.65-0.82, respectively, p < 0.0001) and 4 years (HR 0.83, 95% CI 0.78-0.87, and HR 0.76, 95% CI 0.71-0.83, respectively, p < 0.0001). This association was mostly observed at individual centers where less than 65% of recipients were discharged on the steroid-containing regimen. De novo steroid-free immunosuppression as currently practiced in the United States appears to carry no increased risk of adverse clinical outcomes in the intermediate term.
无类固醇方案在各个移植中心的肾移植受者中越来越多地被采用。然而，由于这种方法对长期移植物和患者存活的影响尚不清楚，人们仍然心存担忧。我们在美国一个基于人群的肾移植受者队列中研究了无类固醇免疫抑制的结果。将2000年1月1日至2006年12月31日期间接受移植的所有成年单肾移植受者，根据出院时是否被选择采用无类固醇或含类固醇方案进行分层。使用多变量Cox回归模型来估计移植物和患者的存活率。分析了个体移植中心的实践模式对类固醇使用的影响。在95755名肾移植受者中，17.2%在出院时采用无类固醇方案（n = 16491）。选择无类固醇方案与1年时移植物失败和死亡风险降低相关（HR分别为0.78，95%CI为0.72 - 0.85，以及HR为0.73，95%CI为0.65 - 0.82，p < 0.0001），4年时也是如此（HR分别为0.83，95%CI为0.78 - 0.87，以及HR为0.76，95%CI为0.71 - 0.83，p < 0.0001）。这种关联大多在个体中心观察到，这些中心中接受含类固醇方案出院的受者不到65%。在美国目前实施的新发无类固醇免疫抑制在中期似乎不会增加不良临床结局的风险。
