Terasaki Foundation Laboratory, 11570 W Olympic Blvd., Los Angeles, CA 90064, USA.
Chin Med J (Engl). 2011 Mar;124(5):649-54.
The status of sensitization in kidney transplant recipients in the last 10 years and the trend of induction and maintenance therapy in patients of different panel-reactive antibody (PRA) levels have not been analyzed. The aim of this study was to investigate the current status of pre-transplant sensitization and its association with graft outcome.
A total of 155 570 kidney transplants reported to United Network for Organ Sharing (UNOS) during 2000 - 2009 were included in this study. We investigated the current status of pre-transplant sensitization and its association with graft outcome, and also compared the usage trend of 16 induction agents and 7 maintenance immunosuppressants in patients at different PRA levels. The difference of distributions of categorical variables between groups was investigated using the chi-square test. Unpaired t test or one-way analysis of variance (ANOVA) were used for numerical variables. The survival rates of transplant recipients were estimated using Kaplan-Meier methods and significance was determined by Log-rank test. Two-side P value < 0.05 was considered statistically significant. All statistical analyses were performed using STATA 10 with all available updates as of March 2010 (StataCorp LP, College Station, Texas 77845, USA).
Despite the fact of the decreased percentages of kidney transplant recipients with presensitization history, the mean PRA levels of all kidney recipients has been increasing in the last 7 years, which was possibly due to the introduction of more sensitive antibody testing techniques. The percentage of patients with treated rejection episodes within one year post-transplant were significantly higher in sensitized patients (PRA = 50% - 100%:14.3% and PRA = 1% - 49%:13.9%) than in non-sensitized patients (12.4%). Both 1- and 5-year graft survival rates improved in the last 10 years; this was more significant in high PRA patients. Thymoglobulin was the most commonly used induction agent in last 10 years. Its users increased from 10% to 46% in non-sensitized patients, from 12% to 57% in PRA 1% - 49% patients, and from 19% to 63% in PRA 50% - 100% patients. The users of Campath, intravenous immunoglobulin (IVIG), and Rituximab have been increasing and reached 16%, 20%, and 11% in highly sensitized patients. In the last 5 years, steroid-free patients were 33% - 36%, 30% - 37%, and 10% - 25% for PRA 0, 1% - 49%, and 50% - 100% respectively. Almost 90% of patients were on Prograf at discharge. It seems that Myfortic users have been increasing since 2005 and it may soon replace mycophenolate mofetil (MMF) if long-term follow-up study conforms its safety and efficacy.
Application of sensitive antibody testing techniques increased the mean PRA levels of transplant recipients in spite of a decreased percentage of sensitized recipients. Induction and maintenance therapy differed in patients at different PRA levels.
过去 10 年中，肾移植受者致敏状态以及不同 panel-reactive antibody (PRA) 水平患者的诱导和维持治疗趋势尚未得到分析。本研究旨在调查移植前致敏的现状及其与移植物结局的关系。
本研究共纳入 2000 年至 2009 年期间向美国器官共享联合网络（UNOS）报告的 155570 例肾移植。我们调查了移植前致敏的现状及其与移植物结局的关系，并比较了不同 PRA 水平患者使用 16 种诱导剂和 7 种维持免疫抑制剂的趋势。使用卡方检验比较组间分类变量的分布差异。对于数值变量，使用未配对 t 检验或单因素方差分析（ANOVA）。使用 Kaplan-Meier 方法估计移植受者的存活率，并通过 Log-rank 检验确定显著性。双侧 P 值<0.05 被认为具有统计学意义。所有统计分析均使用截至 2010 年 3 月（StataCorp LP，德克萨斯州 College Station 77845，美国）的所有可用更新版本的 STATA 10 进行。
尽管致敏史的肾移植受者比例有所下降，但过去 7 年中所有肾移植受者的平均 PRA 水平一直在升高，这可能是由于更敏感的抗体检测技术的引入。在移植后 1 年内接受治疗的排斥反应患者在致敏患者（PRA=50%-100%：14.3%和 PRA=1%-49%：13.9%）中明显高于非致敏患者（12.4%）。在过去 10 年中，1 年和 5 年移植物存活率均有所提高；这在高 PRA 患者中更为显著。胸腺球蛋白是过去 10 年中最常用的诱导剂。在非致敏患者中，其使用者从 10%增加到 46%，在 PRA 1%-49%的患者中从 12%增加到 57%，在 PRA 50%-100%的患者中从 19%增加到 63%。Campath、静脉注射免疫球蛋白（IVIG）和利妥昔单抗的使用者不断增加，高度致敏患者的使用者分别达到 16%、20%和 11%。在过去 5 年中，无激素患者的比例分别为 PRA 0、1%-49%和 50%-100%的 33%-36%、30%-37%和 10%-25%。几乎 90%的患者出院时服用 Prograf。Myfortic 的使用者似乎自 2005 年以来一直在增加，如果长期随访研究证实其安全性和疗效，它可能很快会取代吗替麦考酚酯（MMF）。
尽管致敏受者的比例有所下降，但应用敏感抗体检测技术提高了移植受者的平均 PRA 水平。不同 PRA 水平的患者诱导和维持治疗不同。
