Boyd Alexander, Brown Andrew, Patel Jaimin, Nightingale Peter, Perera M Thamara P R, Ferguson James, Neuberger James, Rajoriya Neil
The Liver Unit, NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom; The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; The Liver Unit, University of Birmingham, Birmingham, United Kingdom.
The Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Transplant Proc. 2021 Jun;53(5):1541-1547. doi: 10.1016/j.transproceed.2021.04.001. Epub 2021 May 29.
Acute kidney injury (AKI) is common after liver transplantation (LT). Induction with interleukin-2 receptor antagonists is often used as a "renal-sparing" strategy. The aim of this study was to assess this approach in a real-world setting in an LT center.
A retrospective cohort analysis of LTs between 2011 and 2018 was performed to assess the impact of a renal-sparing strategy using basiliximab in conjunction with mycophenolate mofetil and corticosteroids from day 0 post-LT along with delayed introduction of tacrolimus. This was compared with a group receiving tacrolimus, mycophenolate mofetil, and corticosteroids from the outset.
The renal-sparing regimen was associated with significantly lower incidence of all-stage AKI at day 7 post-LT (36% vs 55%, P = .006) and less decline in renal function at 3 months (39% vs 57%, P = .01). No further significant differences in renal outcomes were observed at other time points on follow-up to 1 year post-LT. There was no significant difference in the incidence of acute cellular rejection, inpatient length of stay or graft survival. The decision to adopt a renal-sparing regimen was predominantly made on a clinically reactive basis within the first 24 hours post-LT in 77%, and was preordained in 23%. Cost-effectiveness analysis did not find evidence of a significant cost saving when using a renal-sparing strategy.
This study provides real-world analysis of the use of a renal-sparing immunosuppression regimen in LT. Although improvements in incidence of AKI in the short term were demonstrated, this did not translate to cost savings or improved renal outcomes after 3 months.
急性肾损伤（AKI）在肝移植（LT）后很常见。使用白细胞介素-2受体拮抗剂进行诱导治疗常被用作一种“肾脏保护”策略。本研究的目的是在一个肝移植中心的实际环境中评估这种方法。
对2011年至2018年间的肝移植进行回顾性队列分析，以评估从肝移植术后第0天开始使用巴利昔单抗联合霉酚酸酯和皮质类固醇，并延迟引入他克莫司的肾脏保护策略的影响。将其与从一开始就接受他克莫司、霉酚酸酯和皮质类固醇治疗的组进行比较。
肾脏保护方案与肝移植术后第7天所有阶段AKI的发生率显著降低相关（36%对55%，P = 0.006），且3个月时肾功能下降较少（39%对57%，P = 0.01）。在肝移植术后1年的随访中，在其他时间点未观察到肾脏结局有进一步的显著差异。急性细胞排斥反应的发生率、住院时间或移植物存活率无显著差异。77%的患者在肝移植术后的前24小时内主要基于临床反应决定采用肾脏保护方案，23%是预先确定的。成本效益分析未发现使用肾脏保护策略有显著成本节约的证据。
本研究提供了对肝移植中使用肾脏保护免疫抑制方案的实际分析。虽然短期内AKI的发生率有所改善，但这并未转化为成本节约或3个月后肾脏结局的改善。
