Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium.
Am J Transplant. 2012 Oct;12(10):2730-43. doi: 10.1111/j.1600-6143.2012.04144.x. Epub 2012 Jun 13.
Steroid avoidance is safe and effective in children receiving kidney transplants in terms of graft function and survival, but the effects on allograft histology are unknown. In this multicenter trial, 130 pediatric renal transplant recipients were randomized to steroid-free (SF; n = 60) or steroid-based (SB; n = 70) immunosuppression, and underwent renal allograft biopsies at the time of graft dysfunction and per protocol at implantation and 6, 12 and 24 months after transplantation. Clinical follow-up was 3 years posttransplant. Subclinical acute rejection was present in 10.6% SF versus 11.3% SB biopsies at 6 months (p = 0.91), 0% SF versus 4.3% SB biopsies at 1 year (p = 0.21) and 0% versus 4.8% at 2 years (p = 0.20). Clinical acute rejection was present in 13.3% SF and 11.4% SB patients by 1 year (p = 0.74) and in 16.7% SF and 17.1% SB patients by 3 years (p = 0.94) after transplantation. The cumulative incidence of antibody-mediated rejection was 6.7% in SF and 2.9% in SB by 3 years after transplantation (p = 0.30). There was a significant increase in chronic histological damage over time (p < 0.001), without difference between SF and SB patients. Smaller recipient size and higher donor age were the main risk factors for chronic histological injury in posttransplant biopsies.
在接受肾移植的儿童中，避免使用类固醇在移植物功能和存活率方面是安全有效的，但对同种异体移植组织学的影响尚不清楚。在这项多中心试验中，130 名接受肾移植的儿科患者被随机分为无类固醇（SF；n=60）或基于类固醇（SB；n=70）免疫抑制组，并在移植物功能障碍时以及根据方案在移植时和移植后 6、12 和 24 个月进行了肾同种异体移植活检。临床随访时间为移植后 3 年。在 6 个月时，SF 组有 10.6%的患者出现亚临床急性排斥反应，而 SB 组为 11.3%（p=0.91）；SF 组有 0%的患者出现 1 年时的临床急性排斥反应，而 SB 组为 4.3%（p=0.21）；SF 组有 0%的患者出现 2 年时的临床急性排斥反应，而 SB 组为 4.8%（p=0.20）。SF 组和 SB 组在 1 年时分别有 13.3%和 11.4%的患者出现临床急性排斥反应（p=0.74），在 3 年时分别有 16.7%和 17.1%的患者出现临床急性排斥反应（p=0.94）。SF 组在移植后 3 年时抗体介导的排斥反应累积发生率为 6.7%，而 SB 组为 2.9%（p=0.30）。随着时间的推移，慢性组织学损伤呈显著增加趋势（p<0.001），但 SF 组和 SB 组之间无差异。较小的受者体型和较高的供者年龄是移植后活检中慢性组织学损伤的主要危险因素。
