Scott and White Healthcare, Temple, TX, USA.
Clin Transplant. 2014 Feb;28(2):184-91. doi: 10.1111/ctr.12294. Epub 2013 Dec 24.
Mycophenolic acid Observational REnal transplant (MORE) was a prospective, observational study of de novo kidney transplant patients receiving mycophenolic acid (MPA). Four-yr data on 904 patients receiving tacrolimus and enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) were analyzed to evaluate immunosuppression and graft outcomes in African American (AA, n = 218) vs. non-AA (n = 686) patients. Mean tacrolimus dose was higher in AA vs. non-AA patients but mean tacrolimus trough concentration was similar. Use of the recommended MPA dose in AA patients decreased from 78.9% at baseline to 33.1% at year 3. More AA patients received the recommended MPA dose with EC-MPS than MMF at month 6 (56.2% vs. 35.7%, p = 0.016) and month 36 (46.6% vs. 16.7%, p = 0.029), with no safety penalty. Significantly, more AA patients received corticosteroids than non-AA patients. Biopsy-proven acute rejection was higher in AA vs. non-AA patients (18.9% vs. 10.7%, p = 0.003), as was graft loss (10.9% vs. 4.4%, p = 0.003); differences were confirmed by Cox regression analysis. Patient survival was similar. Estimated GFR was comparable in AA vs. non-AA patients. Kidney allograft survival remains lower for AA vs. non-AA recipients even under the current standard of care.
霉酚酸观察性肾移植（MORE）是一项新诊断肾移植患者接受霉酚酸（MPA）的前瞻性观察性研究。分析了 904 例接受他克莫司和肠溶性吗替麦考酚酯钠（EC-MPS）或吗替麦考酚酯（MMF）的患者的 4 年数据，以评估非洲裔美国人（AA，n=218）与非 AA 患者（n=686）的免疫抑制和移植物结局。AA 患者的平均他克莫司剂量高于非 AA 患者，但平均他克莫司谷浓度相似。AA 患者推荐的 MPA 剂量从基线时的 78.9%下降到第 3 年时的 33.1%。与 MMF 相比，在第 6 个月（56.2% vs. 35.7%，p=0.016）和第 36 个月（46.6% vs. 16.7%，p=0.029）时，更多的 AA 患者接受了 EC-MPS 推荐的 MPA 剂量，且没有安全问题。重要的是，与非 AA 患者相比，更多的 AA 患者接受了皮质类固醇治疗。AA 患者的活检证实的急性排斥反应发生率高于非 AA 患者（18.9% vs. 10.7%，p=0.003），移植物丢失率也更高（10.9% vs. 4.4%，p=0.003）；Cox 回归分析证实了这一点。患者生存率相似。AA 患者和非 AA 患者的估计肾小球滤过率（eGFR）相当。即使在当前的标准治疗下，AA 患者的肾移植存活率仍低于非 AA 患者。
