Salcedo-Herrera Sergio, Pinto Ramirez Jessica L, García-Lopez Andrea, Amaya-Nieto Javier, Girón-Luque Fernando
Department of Transplantation Nephrology, Colombiana de Trasplantes, Bogotá, Colombia.
Department of Transplantation Nephrology, Colombiana de Trasplantes, Bogotá, Colombia.
Transplant Proc. 2019 Jul-Aug;51(6):1758-1762. doi: 10.1016/j.transproceed.2019.04.048.
Although tacrolimus is an effective immunosuppressive drug used for preventing biopsy proven acute rejection (BPAR) in kidney transplanted patients, its nephrotoxicity may compromise renal function and lead to delayed initiation because of its side effects. This study aimed to evaluate the safety of early initiation of tacrolimus in the occurrence of BPAR during the first 90 days post transplant.
We conducted a retrospective cohort study involving 315 patients who underwent kidney transplantation from 2015 to 2017. Comparisons were performed between 2 groups according to whether the start time of tacrolimus therapy was delayed or not delayed. Cox proportional hazards models were used to examine the association between variables and the occurrence of BPAR.
The incidence of BPAR was 14.9% (n = 47) and it was significantly higher in the delayed group (19.4% vs 6.4%; P = .002). Delayed initiation tacrolimus group was significantly associated with the risk of BPAR (hazard ratio: 2.95; P < .036). The overall mortality rate was 2.5% (n = 8) and there was no association between delayed initiation therapy and death (P = .56).
Our study confirmed that delayed initiation of tacrolimus in patients with delayed graft function is associated with a high risk of BPAR.
尽管他克莫司是一种有效的免疫抑制药物，用于预防肾移植患者经活检证实的急性排斥反应（BPAR），但其肾毒性可能会损害肾功能，并因其副作用导致延迟用药。本研究旨在评估肾移植术后90天内早期使用他克莫司在发生BPAR时的安全性。
我们进行了一项回顾性队列研究，纳入了2015年至2017年接受肾移植的315例患者。根据他克莫司治疗开始时间是否延迟，将两组患者进行比较。采用Cox比例风险模型来检验变量与BPAR发生之间的关联。
BPAR的发生率为14.9%（n = 47），延迟组的发生率显著更高（19.4%对6.4%；P = .002）。延迟开始使用他克莫司组与BPAR风险显著相关（风险比：2.95；P < .036）。总死亡率为2.5%（n = 8），延迟开始治疗与死亡之间无关联（P = .56）。
我们的研究证实，移植肾功能延迟患者延迟使用他克莫司与BPAR的高风险相关。
