Sharif Adnan, Chand Sourabh, Krishnan Hari, Smith Samuel, Markarian Nina, Borrows Richard, Cockwell Paul
Department of Nephrology and Transplantation, Renal Institute of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Exp Clin Transplant. 2011 Aug;9(4):236-40.
Some patients needing a kidney transplant have used cyclophosphamide before the transplant. Long-term bone marrow damage associated with cyclophosphamide could manifest with myelotoxic complications after transplant in the context of the immunosuppressant, but evidence for this has not been published.
We performed a retrospective, single-center analysis of renal transplant recipients with prior cyclophosphamide exposure and compared posttransplant short-term outcomes to a random control group (clinical outcomes identified by searching automated electronic databases).
Sixteen recipients had taken cyclophosphamide before the transplant and were compared with a control group of 32 patients. Hospitalization rates were equal, and although there were 3 times more hospitalizations secondary to an infective course in the cyclophosphamide group, this did not achieve significance (0.63 vs 0.22; P = .147). There was no difference in rates of bacteriuria, cytomegalovirus, or Polyomavirus. The cyclophosphamide group was at significantly greater risk of needing a blood transfusion immediately after the transplant (average number of units of blood per patient, 0.44 vs 0.19; P = .038). Also, they were 3 times more likely to require anemia treatments 1 year after the transplant (average number of anemia treatment medications, 0.75 vs 0.25; P = .014). Full blood count parameters, graft function, and graft and patient survival at 1 year posttransplant were equal.
Evidence suggests that pretransplant administration of cyclophosphamide is associated with adverse short-term outcomes posttransplant. Further analyses are warranted to investigate these preliminary findings to determine whether myelosuppressive immunosuppressant should be modified in the context of prior cyclophosphamide exposure.
一些需要进行肾移植的患者在移植前使用过环磷酰胺。与环磷酰胺相关的长期骨髓损伤可能在移植后免疫抑制剂的作用下表现为骨髓毒性并发症，但相关证据尚未发表。
我们对先前接触过环磷酰胺的肾移植受者进行了一项回顾性单中心分析，并将移植后的短期结果与随机对照组进行比较（通过搜索自动化电子数据库确定临床结果）。
16名受者在移植前服用过环磷酰胺，并与32名患者的对照组进行比较。住院率相当，虽然环磷酰胺组因感染病程导致的住院次数多出3倍，但这未达到显著差异（0.63对0.22；P = 0.147）。菌尿、巨细胞病毒或多瘤病毒的发生率没有差异。环磷酰胺组在移植后立即需要输血的风险显著更高（每位患者的平均输血量，0.44对0.19；P = 0.038）。此外，他们在移植后1年需要进行贫血治疗的可能性高出3倍（贫血治疗药物的平均数量，0.75对0.25；P = （0.014）。移植后1年的全血细胞计数参数、移植肾功能以及移植肾和患者的存活率相当。
有证据表明移植前给予环磷酰胺与移植后不良短期结果相关。有必要进行进一步分析以研究这些初步发现，以确定在先前接触环磷酰胺的情况下是否应调整骨髓抑制性免疫抑制剂。
