肝-肾联合移植受者的皮质类固醇消除。

Corticosteroid elimination in simultaneous liver-kidney transplantation recipients.

机构信息

Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Aurora, CO, USA.

出版信息

Clin Transplant. 2009 Nov-Dec;23(6):958-63. doi: 10.1111/j.1399-0012.2009.01051.x. Epub 2009 Aug 2.

DOI:10.1111/j.1399-0012.2009.01051.x

PMID:19664017

Abstract

BACKGROUND

Simultaneous liver-kidney transplantation (SLK) has more than doubled since 2002. While less common in kidney transplant alone recipients (KTA), corticosteroid discontinuation is performed routinely in liver transplantation, raising the question of optimal immunosuppression for SLK recipients.

METHODS

A retrospective case series of 16 SLK recipients under a steroid withdrawal protocol was performed to compare short-term outcomes to a contemporaneous cohort of 32 KTA recipients.

RESULTS

In 69% of SLK recipients, corticosteroids were eliminated compared to 3% of KTA recipients, p < 0.0001. When comparing SLK and KTA recipients one yr post-transplant, there were no significant differences in renal graft rejection (23.1% vs. 6.3%), death-censored renal graft survival (100% vs. 97%), estimated glomerular filtration rate (74.4 vs. 62.6 mL/min), serum creatinine (1.10 vs. 1.39 mg/dL), or maintenance immunosuppression, respectively.

CONCLUSIONS

Corticosteroids may be withdrawn safely in SLK recipients with one-yr renal outcomes comparable to a KTA cohort.

摘要

背景

自 2002 年以来，同期肝肾移植（SLK）的数量增加了一倍多。虽然在单独接受肾移植的患者（KTA）中较少见，但肝移植中常规停用皮质类固醇，这引发了 SLK 受者最佳免疫抑制的问题。

方法

对接受类固醇停药方案的 16 例 SLK 受者进行回顾性病例系列研究，以将短期结果与同期 32 例 KTA 受者的队列进行比较。

结果

在 69%的 SLK 受者中，皮质类固醇被消除，而在 KTA 受者中仅为 3%，p<0.0001。在比较 SLK 和 KTA 受者移植后 1 年时，肾移植物排斥的发生率（23.1%比 6.3%）、死亡相关的肾移植物存活率（100%比 97%）、估计肾小球滤过率（74.4 比 62.6 mL/min）、血清肌酐（1.10 比 1.39 mg/dL）或维持性免疫抑制均无显著差异。