Liu Y, Liu H, Shen Y, Chen Y, Cheng Y
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2018 Oct;50(8):2368-2370. doi: 10.1016/j.transproceed.2018.03.101. Epub 2018 Mar 20.
Tacrolimus is widely used in renal transplantation to help prevent acute and chronic rejection, but the nephrotoxicity of tacrolimus may compromise renal function. This study investigates the safety and efficacy in delayed initiation of tacrolimus after antilymphocyte induction therapy in kidney transplant recipients.
This retrospective cohort analysis involved data from 68 kidney transplant recipients receiving standard induction therapy (basiliximab [Simulect] or thymoglobulin) combined with tacrolimus. The patients were divided into 2 groups according to whether the start time of tacrolimus therapy was before or after 24 hours posttransplantation. Acute rejection, common complications of immunosuppression, and graft survival were compared.
The mean (SD) timing of tacrolimus administered in the Delayed group was 4 (1.9) days after transplantation. The Delayed group patients had a higher percentage of slow graft function and delayed graft function than the No-delay group. Compared with the No-delay group, delayed initiation of tacrolimus did not increase risk of biopsy-proven acute rejection, infection, posttransplant diabetes mellitus, graft survival, and patient survival.
Our study confirmed delayed initiation of tacrolimus after antilymphocyte induction therapy is safe and effective in renal transplant recipients with slow or delayed graft function.
他克莫司广泛用于肾移植以预防急性和慢性排斥反应，但他克莫司的肾毒性可能损害肾功能。本研究调查了肾移植受者在抗淋巴细胞诱导治疗后延迟启动他克莫司的安全性和有效性。
这项回顾性队列分析涉及68例接受标准诱导治疗（巴利昔单抗[舒莱]或抗胸腺细胞球蛋白）联合他克莫司的肾移植受者的数据。根据他克莫司治疗开始时间是在移植后24小时之前还是之后，将患者分为两组。比较急性排斥反应、免疫抑制常见并发症和移植物存活率。
延迟组他克莫司给药的平均（标准差）时间为移植后4（1.9）天。延迟组患者缓慢移植肾功能和延迟移植肾功能的比例高于无延迟组。与无延迟组相比，延迟启动他克莫司并未增加活检证实的急性排斥反应、感染、移植后糖尿病、移植物存活率和患者存活率的风险。
我们的研究证实，在具有缓慢或延迟移植肾功能的肾移植受者中，抗淋巴细胞诱导治疗后延迟启动他克莫司是安全有效的。
