Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2021 Mar;53(2):645-648. doi: 10.1016/j.transproceed.2020.11.005. Epub 2020 Dec 25.
Acute kidney injury (AKI) is common after liver transplantation and affects outcome after liver transplantation. Antibody induction is commonly used to reduce dose and/or to delay introduction of calcineurin inhibitor (CNI) but is very expensive. We propose a modified immunosuppressive protocol that delays administration of CNI for 48 to 72 hours without antibody induction. This study evaluates the results of our new protocol.
A retrospective case-control study was performed. Study patients had induction with steroid and mycophenolate mofetil without antibody induction, and CNI administration was delayed for 48 to 72 hours. Control patients received CNI and steroid induction without antibody induction, and CNI was continued posttransplant. AKI was defined as an increase in serum creatinine level of at least 1.5 times the pretransplant baseline within the first postoperative week.
Sixty liver transplant recipients from 2013 to 2015 were included in this study (30 in the delayed CNI group and 30 in the control group). The patient characteristics and intraoperative factors were comparable in both groups. AKI developed in 11 patients in the study group and in 20 patients in the control group (37% vs 66.7%; P = .02). There was no acute rejection observed in the first month in either group.
We have demonstrated that delayed CNI introduction without antibody induction is safe and helps preserve kidney function. Antibody induction can be omitted safely in a delayed CNI introduction protocol to reduce the cost of liver transplantation without increasing the risk of acute rejection.
急性肾损伤（AKI）在肝移植后很常见，并影响肝移植后的结果。抗体诱导通常用于减少剂量和/或延迟钙调神经磷酸酶抑制剂（CNI）的引入，但非常昂贵。我们提出了一种改良的免疫抑制方案，延迟 CNI 给药 48 至 72 小时而不使用抗体诱导。本研究评估了我们新方案的结果。
进行了回顾性病例对照研究。研究患者接受类固醇和霉酚酸酯莫福汀诱导，而不使用抗体诱导，并且 CNI 给药延迟 48 至 72 小时。对照患者接受 CNI 和类固醇诱导，而不使用抗体诱导，并且 CNI 在移植后继续使用。AKI 的定义为术后第一周内血清肌酐水平至少增加 1.5 倍于移植前基线。
本研究纳入了 2013 年至 2015 年的 60 例肝移植患者（延迟 CNI 组 30 例，对照组 30 例）。两组患者的特征和术中因素相似。研究组中有 11 例患者发生 AKI，对照组中有 20 例患者发生 AKI（37%比 66.7%；P=0.02）。两组在第一个月内均未观察到急性排斥反应。
我们已经证明，延迟 CNI 引入而不使用抗体诱导是安全的，可以帮助保护肾功能。在延迟 CNI 引入方案中可以安全省略抗体诱导，以降低肝移植的成本，而不会增加急性排斥反应的风险。
