肾移植受者移植后早期血细胞减少症的发生情况
Cytopenia Occurrence in Kidney Transplant Recipients Within Early Post-transplant Period.
作者信息
Jafari Atefeh, Najivash Parisa, Khatami Mohammad-Reza, Dashti-Khavidaki Simin
机构信息
Department of Clinical Pharmacy, Guilan University of Medical Sciences, Rasht, Iran.
Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
J Res Pharm Pract. 2017 Jan-Mar;6(1):31-39. doi: 10.4103/2279-042X.200983.
OBJECTIVE
This study assessed incidence, severity, and time to occurrence of drug-induced leukopenia/thrombocytopenia within 1 month after kidney transplantation.
METHODS
This cross-sectional study was conducted on newly kidney transplant recipients from two hospitals, Iran. Patients with thrombocytopenia due to acute antibody-mediated rejection were excluded from the study. Demographic, clinical, and laboratory data of patients within the 1 month after transplantation were collected.
FINDINGS
Of 213 patients, 14.1% and 66.2% experienced leukopenia and thrombocytopenia, respectively. Cytopenia happened more commonly among patients with thymoglobulin-containing regimen (for leukopenia: 24.6% vs. 0%, < 0.001; for thrombocytopenia 84.4% vs. 41.8%, < 0.001). Most leukopenia patients experienced Grades 1 and 2 of leukopenia (46.6% and 40% of patients). Most thrombocytopenic patients showed Grade 1 of thrombocytopenia (78.7%). Cumulative dose of thymoglobulin did not differ between patients with and without leukopenia (5.57 ± 1.13 vs. 5.9 ± 1.96 mg/kg; = 0.613) or with and without thrombocytopenia (5.87 ± 1.86 vs. 5.56 ± 1.38 mg/kg; = 0.29). Cytopenia were more common among recipients from deceased compared with from living donors (91.3% vs. 8.7% for leukopenia patients, = 0.001; 69.9% vs. 33.1% for thrombocytopenia, = 0.02). More patients with kidney from deceased donors received thymoglobulin in their immunosuppressive regimen (82% vs. 37%; < 0.001). The median time to leukopenia and thrombocytopenia were 3 days and 1 day, respectively.
CONCLUSION
Among immunosuppressive and prophylactic antimicrobial agents, thymoglobulin is more related to cytopenia; therefore, thymoglobulin dose reduction is recommended as the first intervention to manage cytopenia without need for reduction of its cumulative dose. The higher prevalence of cytopenia among recipients from deceased donors may be related to the higher use of thymoglobulin in these patients.
目的
本研究评估肾移植术后1个月内药物性白细胞减少/血小板减少的发生率、严重程度及发生时间。
方法
本横断面研究对来自伊朗两家医院的新发肾移植受者进行。因急性抗体介导排斥反应导致血小板减少的患者被排除在研究之外。收集移植后1个月内患者的人口统计学、临床和实验室数据。
结果
213例患者中，分别有14.1%和66.2%发生白细胞减少和血小板减少。细胞减少症在接受含抗胸腺细胞球蛋白方案治疗的患者中更为常见（白细胞减少：24.6%对0%，<0.001；血小板减少：84.4%对41.8%，<0.001）。大多数白细胞减少患者为1级和2级白细胞减少（分别占患者的46.6%和40%）。大多数血小板减少患者为1级血小板减少（78.7%）。有白细胞减少和无白细胞减少患者的抗胸腺细胞球蛋白累积剂量无差异（5.57±1.13对5.9±1.96mg/kg；P=0.613），有血小板减少和无血小板减少患者的抗胸腺细胞球蛋白累积剂量也无差异（5.87±1.86对5.56±1.38mg/kg；P=0.29）。与活体供者来源的受者相比，死亡供者来源的受者中细胞减少症更为常见（白细胞减少患者：91.3%对8.7%，P=0.001；血小板减少：69.9%对33.1%，P=0.02）。更多接受死亡供者肾脏的患者在免疫抑制方案中使用了抗胸腺细胞球蛋白（82%对37%；<0.001）。白细胞减少和血小板减少的中位时间分别为3天和1天。
结论
在免疫抑制和预防性抗菌药物中，抗胸腺细胞球蛋白与细胞减少症的相关性更大；因此，建议将减少抗胸腺细胞球蛋白剂量作为处理细胞减少症的首要干预措施，而无需减少其累积剂量。死亡供者来源的受者中细胞减少症患病率较高可能与这些患者中抗胸腺细胞球蛋白的使用较多有关。
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