低剂量他克莫司方案对肾移植后 7 年随访中新发供者特异性抗体出现的影响。
Influence of a low-dose tacrolimus protocol on the appearance of de novo donor-specific antibodies during 7 years of follow-up after renal transplantation.
机构信息
Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Nephrology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
出版信息
Nephrol Dial Transplant. 2021 May 27;36(6):1120-1129. doi: 10.1093/ndt/gfaa258.
BACKGROUND
Tacrolimus (TAC) is a key immunosuppressant drug for kidney transplantation (KTx). However, the optimal serum trough level of TAC for good long-term outcomes remains unclear. This study aimed to investigate the relationship between the maintenance TAC trough level and the appearance of de novo donor-specific anti-human leukocyte antigen (HLA) antibodies (dnDSAs).
METHODS
A total of 584 KTx recipients were enrolled in this study, of whom 164 developed dnDSAs during the follow-up period and 420 did not.
RESULTS
We found no significant relationship between TAC trough level during the follow-up period and dnDSA incidence. Patients who developed dnDSAs had a significantly greater number of HLA-A/B/DR mismatches (3.4 ± 1.3 versus 2.8 ± 1.5; P < 0.001), were more likely to have preformed DSAs (48.2% versus 27.1%; P < 0.001) and showed poor allograft outcome.
CONCLUSIONS
There was no clear relationship between TAC trough level and dnDSA incidence for KTx recipients whose TAC trough levels were kept within the narrow range of 4-6 ng/mL during the immunosuppression maintenance period.
背景
他克莫司（TAC）是肾移植（KTx）的关键免疫抑制剂药物。然而，TAC 的最佳维持血药谷浓度以获得良好的长期效果仍不清楚。本研究旨在探讨维持性 TAC 血药谷浓度与新出现的供体特异性抗人白细胞抗原（HLA）抗体（dnDSA）之间的关系。
方法
本研究共纳入 584 例 KTx 受者，其中 164 例在随访期间出现 dnDSA，420 例未出现 dnDSA。
结果
我们发现，在随访期间，TAC 血药谷浓度与 dnDSA 发生率之间没有显著关系。发生 dnDSA 的患者 HLA-A/B/DR 错配数明显较多（3.4±1.3 对 2.8±1.5；P<0.001），更有可能预先存在 DSAs（48.2%对 27.1%；P<0.001），且移植物预后不良。
结论
在免疫抑制维持期 TAC 血药谷浓度保持在 4-6ng/mL 的狭窄范围内的 KTx 受者中，TAC 血药谷浓度与 dnDSA 发生率之间没有明确关系。
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