Australia and New Zealand Dialysis and Transplant Registry, Royal Adelaide Hospital, Australia.
Am J Transplant. 2011 Aug;11(8):1645-9. doi: 10.1111/j.1600-6143.2011.03667.x.
We studied the impact of steroid use on kidney graft loss due to recurrent IgA nephropathy (IgAN). We used data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) to conduct a survival analysis of adult recipients of a first kidney transplant for IgAN who received a graft between 1988 and 2007. Predictors of graft loss due to recurrent IgAN were analyzed in a competing risk survival analysis with steroid use modeled as a time-varying covariate. Fifteen hundred twenty-one recipients with kidney failure due to biopsy-proven IgAN received a first kidney transplant during the study period. Four hundred and twenty-eight recipients experienced graft loss, of which 54 losses (12.6%) were attributed to recurrent IgAN. The overall 10-year cumulative incidence of graft loss from recurrent IgAN was 4.3% (95% CI 3.1-5.8). Prevalence of steroid use was 92% at baseline, 84% at 1 year and 64% at 5 years. After adjusting for age, sex, HLA mismatch, dialysis duration and transplant era, steroid use was strongly associated with a reduced risk of recurrence (subhazard ratio 0.50, 95% CI 0.30-0.84). These results suggest that the risk of graft loss from recurrent disease should be considered when tailoring immunosuppression for patients with IgAN.
我们研究了类固醇使用对因复发性 IgA 肾病（IgAN）导致的肾移植物丢失的影响。我们使用澳大利亚和新西兰透析和移植登记处（ANZDATA）的数据，对 1988 年至 2007 年间接受首次 IgAN 肾移植且接受移植物的成年受者进行生存分析。使用竞争风险生存分析分析复发性 IgAN 导致移植物丢失的预测因素，类固醇使用作为时变协变量进行建模。在研究期间，有 1521 名因活检证实的 IgAN 导致肾功能衰竭的受者接受了首次肾移植。428 名受者经历了移植物丢失，其中 54 例（12.6%）归因于复发性 IgAN。复发性 IgAN 导致的移植物丢失的总体 10 年累积发生率为 4.3%（95%CI 3.1-5.8）。基线时类固醇使用率为 92%，1 年时为 84%，5 年时为 64%。在调整年龄、性别、HLA 错配、透析持续时间和移植时代后，类固醇使用与复发风险降低显著相关（亚危险比 0.50，95%CI 0.30-0.84）。这些结果表明，在为 IgAN 患者调整免疫抑制时，应考虑复发性疾病导致移植物丢失的风险。
