Nicholson Michael L, Hoff Mekhola, Leighton Philippa, Mohamed Ismail, Hosgood Sarah A
Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Leicester General Hospital, University of Leicester, Leicester, UK.
Transpl Int. 2020 Dec;33(12):1754-1761. doi: 10.1111/tri.13747. Epub 2020 Nov 9.
The planned nature of live donor kidney transplantation allows for immunosuppression to be initiated in the pretransplant period. The aim of this study was to determine the effect of pre-emptive immunosuppression on acute rejection rates after live donor kidney transplantation. In two consecutive cohorts of live donor kidneys transplants, 99 patients received pre-emptive immunosuppression with tacrolimus monotherapy for 2 weeks prior to transplantation (PET group - first era) and 100 patients received tacrolimus-based immunosuppression commencing on the day of transplantation (control group - second era). The main outcome measure was the incidence of biopsy-proven acute rejection (BPAR) in the first 3 months post-transplantation. Tacrolimus levels were significantly higher in the PET group at day 4 post-transplant (PET 9.08 ± 4.57 vs. control 5.92 ± 3.64 ng/ml; P < 0.0001), but there were no significant differences in tacrolimus levels at day 7 (PET 8.22 ± 3.58 vs. control 7.63 ± 3.56 ng/ml; P = 0.2452). BPAR was numerically higher in the PET group, but this difference did not reach statistical significance (PET 13/99 vs. control 6/100; P = 0.097). There were no differences in allograft function measured by serum creatinine at 1 year (PET 130 ± 36 vs. control 142 ± 69 μmol/l; P = 0.6829). Graft survival at 1 year was equivalent in both groups (PET 96.9 vs. control 97.0%; P = 0.9915). This study suggests that there is little role for the use of pre-emptive tacrolimus monotherapy in ABO blood group and HLA-compatible live donor kidney transplantation in patients on triple maintenance immunosuppression.
活体供肾移植的计划性使得在移植前阶段即可开始免疫抑制治疗。本研究的目的是确定抢先免疫抑制对活体供肾移植术后急性排斥反应发生率的影响。在连续两个队列的活体供肾移植中，99例患者在移植前2周接受了他克莫司单药抢先免疫抑制治疗（PET组 - 第一阶段），100例患者在移植当天开始接受基于他克莫司的免疫抑制治疗（对照组 - 第二阶段）。主要观察指标是移植后前3个月经活检证实的急性排斥反应（BPAR）的发生率。移植后第4天，PET组的他克莫司水平显著更高（PET组9.08±4.57 vs.对照组5.92±3.64 ng/ml；P<0.0001），但第7天他克莫司水平无显著差异（PET组8.22±3.58 vs.对照组7.63±3.56 ng/ml；P = 0.2452）。PET组的BPAR在数值上更高，但这种差异未达到统计学意义（PET组13/99 vs.对照组6/100；P = 0.097）。1年时通过血清肌酐测量的移植肾功能无差异（PET组130±36 vs.对照组142±69 μmol/l；P = 0.6829）。两组1年时的移植物存活率相当（PET组96.9% vs.对照组97.0%；P = 0.9915）。本研究表明，在接受三联维持免疫抑制治疗的ABO血型和HLA配型相合的活体供肾移植患者中，使用抢先他克莫司单药治疗作用不大。
