Ryu Jung-Hwa, Choi Sunmi, Lee Hyun Joo, Kim Young Tae, Kim Young Whan, Yang Jaeseok
Transplant Center, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Ann Thorac Med. 2019 Jul-Sep;14(3):186-191. doi: 10.4103/atm.ATM_160_18.
Low-dose tacrolimus-based immunosuppression is a standard therapy in kidney and liver transplantation; however, the optimal therapeutic level of tacrolimus has not been established in lung transplantation. We aimed to identify the tacrolimus level associated with better outcomes in lung transplant patients.
This retrospective study included patients who underwent lung transplantation at Seoul National University Hospital between 2006 and 2016. Kaplan-Meier survival analysis and Cox regression were performed according to tacrolimus levels at several time-points within 1-year posttransplantation.
A total of 43 patients received bilateral lung transplantation. The median age was 53 years and the median follow-up was 20.5 months. Overall and 1-year patient survival rates were 55.8% and 74.4%, respectively. Infection was the most common cause of death (78.9%). Chronic lung allograft dysfunction was observed in 16.3%. A tacrolimus level <9 ng/ml at 1 month was associated with lower rejection-free survival ( = 0.009). A time-averaged tacrolimus level <10 ng/ml within 1 month posttransplantation was an independent risk factor for poor patient survival (hazard ratio: 4.904; 95% confidence interval: 1.930-12.459; = 0.001). Furthermore, higher tacrolimus levels did not increase infectious complications.
These finding suggest that tacrolimus levels ≥10 ng/ml within 1 month after lung transplantation appear to be associated with better patient survival.
基于低剂量他克莫司的免疫抑制是肾移植和肝移植的标准治疗方法；然而，他克莫司在肺移植中的最佳治疗水平尚未确定。我们旨在确定与肺移植患者更好预后相关的他克莫司水平。
这项回顾性研究纳入了2006年至2016年在首尔国立大学医院接受肺移植的患者。根据移植后1年内几个时间点的他克莫司水平进行Kaplan-Meier生存分析和Cox回归分析。
共有43例患者接受了双肺移植。中位年龄为53岁，中位随访时间为20.5个月。总体患者生存率和1年患者生存率分别为55.8%和74.4%。感染是最常见的死亡原因（78.9%）。观察到慢性肺移植功能障碍的发生率为16.3%。移植后1个月时他克莫司水平<9 ng/ml与无排斥反应生存期较低相关（P = 0.009）。移植后1个月内他克莫司平均水平<10 ng/ml是患者生存不良的独立危险因素（风险比：4.904；95%置信区间：1.930 - 12.459；P = 0.001）。此外，较高的他克莫司水平并未增加感染并发症。
这些发现表明，肺移植后1个月内他克莫司水平≥10 ng/ml似乎与患者更好的生存率相关。
