Arora Swati, Marcus Richard J, Dikkala Sudharani, Sureshkumar Kalathil K
Allegheny General Hospital, Pittsburgh, PA, USA.
Exp Clin Transplant. 2009 Dec;7(4):233-6.
Rapid steroid discontinuation immunosuppressive protocols are increasingly used in renal transplant. The optimal immunosuppressive regimen in patients who develop acute rejection while on a rapid steroid discontinuation protocol is less clear. We examined our experience of adding maintenance steroid therapy in renal transplant recipients who developed 1 or more acute rejection episode while on a rapid steroid discontinuation protocol.
The outcome of 145 patients who underwent renal transplant from 2002 to 2007 and initiated a rapid steroid discontinuation protocol was analyzed. Patients were divided into the following 5 groups: (i): acute rejection X 1 and no maintenance steroids, (ii): acute rejection X 1 and started on maintenance steroids, (iii): acute rejection X 2 and no maintenance steroids (iv): acute rejection X 2 and started on maintenance steroids, and (v): no acute rejection
Compared with patients with no acute rejection, graft survival was significantly inferior in patients who experienced 2 or more acute rejection episodes-whether they were started on maintenance steroids (P = .003) or not (P = .006) - but was similar in patients who experienced only 1 episode of acute rejection, and were started either on maintenance steroids (P = .87) or were continued on the rapid steroid discontinuation protocol (P = .69). In patients who sustained 2 episodes of acute rejection, addition of maintenance steroids had no impact on graft survival (P = .97).
More than 1 episode of acute rejection in renal transplant recipients on rapid steroid discontinuation protocol is associated with poor, long-term, graft survival, which remains unchanged despite starting maintenance steroids. The use of maintenance steroids may not have a positive impact on graft survival after acute rejection.
快速停用类固醇免疫抑制方案在肾移植中应用越来越广泛。对于在快速停用类固醇方案期间发生急性排斥反应的患者，最佳免疫抑制方案尚不清楚。我们研究了在采用快速停用类固醇方案的肾移植受者中添加维持类固醇治疗的经验。
分析了2002年至2007年接受肾移植并启动快速停用类固醇方案的145例患者的结局。患者分为以下5组：（i）：急性排斥反应1次且未使用维持类固醇，（ii）：急性排斥反应1次且开始使用维持类固醇，（iii）：急性排斥反应2次且未使用维持类固醇，（iv）：急性排斥反应2次且开始使用维持类固醇，以及（v）：无急性排斥反应。
与无急性排斥反应的患者相比，发生2次或更多次急性排斥反应的患者，无论是否开始使用维持类固醇，移植肾存活率均显著降低（分别为P = 0.003和P = 0.006）；而仅发生1次急性排斥反应的患者，无论开始使用维持类固醇（P = 0.87）还是继续采用快速停用类固醇方案（P = 0.69），移植肾存活率相似。在发生2次急性排斥反应的患者中，添加维持类固醇对移植肾存活率无影响（P = 0.97）。
采用快速停用类固醇方案的肾移植受者发生1次以上急性排斥反应与长期移植肾存活率低相关，尽管开始使用维持类固醇，情况仍无改善。急性排斥反应后使用维持类固醇可能对移植肾存活率无积极影响。
