Division of Transplantation, Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN, USA.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Clin Transplant. 2019 Oct;33(10):e13668. doi: 10.1111/ctr.13668. Epub 2019 Aug 7.
Obese transplant recipients (BMI ≥ 30 kg/m ) have decreased posttransplant patient and graft survival compared with their nonobese counterparts. At the same time, many prednisone-related side effects (eg, new-onset diabetes) are similar to those associated with obesity. Using SRTR data, we studied outcomes associated with prednisone-free maintenance immunosuppression (rapid discontinuation of prednisone-RDP). Between January 1, 2000, and December 31, 2014, 44 635 first transplant recipients with BMI ≥ 30 kg/m had a first kidney transplant (28 176 DD; 16 459, LD); 12,994 (29%) were discharged from the hospital on a prednisone-free protocol. We compared outcomes to those discharged on a protocol incorporating maintenance prednisone (intention-to-treat analysis). RDP-treated obese first DD recipients had significantly better patient survival (HR, 0.88; CI, 0.81-0.96) and graft survival (HR, 0.93; CI, 0.88-0.99) compared with their counterparts on maintenance immunosuppression. Although not statistically significant, the same trends were seen for LD recipients. For both DD and LD recipients, there was no difference between groups for death-censored graft survival, suggesting that the benefit of RDP was due to improved patient survival. Our findings suggest that kidney transplant recipients with BMI ≥ 30 kg/m benefit from a protocol that incorporates RDP.
肥胖的移植受者（BMI≥30kg/m）与非肥胖受者相比，移植后患者和移植物的存活率降低。与此同时，许多与泼尼松相关的副作用（例如新发糖尿病）与肥胖相关的副作用相似。我们利用 SRTR 数据研究了与无泼尼松维持免疫抑制（快速停用泼尼松-RDP）相关的结果。在 2000 年 1 月 1 日至 2014 年 12 月 31 日期间，BMI≥30kg/m的 44635 名首次移植受者接受了首次肾移植（28176 名 DD；16459 名 LD）；12994 名（29%）出院时采用无泼尼松方案。我们将结果与出院时采用维持泼尼松方案的患者进行了比较（意向治疗分析）。与接受维持免疫抑制的肥胖首次 DD 受者相比，接受 RDP 治疗的肥胖首次 DD 受者的患者存活率（HR，0.88；CI，0.81-0.96）和移植物存活率（HR，0.93；CI，0.88-0.99）显著提高。虽然没有统计学意义，但 LD 受者也出现了同样的趋势。对于 DD 和 LD 受者，两组在无死亡censored 移植物存活率方面没有差异，这表明 RDP 的益处归因于患者存活率的提高。我们的研究结果表明，BMI≥30kg/m的肾移植受者从包含 RDP 的方案中获益。
