Cerise Adam, Shaker Tamer, LeNguyen Phuoc, Dinesh Anant, Jackson Scott, Kandaswamy Raja, Riad Samy
Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN.
Complex Care Analytics, M Health Fairview, Minneapolis, MN.
Transplantation. 2023 Feb 1;107(2):521-528. doi: 10.1097/TP.0000000000004295. Epub 2022 Sep 30.
Steroid avoidance in kidney transplantation has been proven noninferior. Long-term outcome data on steroid avoidance in simultaneous pancreas-kidney (SPK) remains scant.
Utilizing the Scientific Registry of Transplant Recipients between 2000 and 2020, we studied all primary crossmatch negative SPK recipients (N = 5683) who received antithymocyte globulin induction and were discharged alive with functioning grafts on tacrolimus and mycophenolate ± steroid maintenance. Recipients were grouped according to steroid use into 2 groups: steroid maintenance (n = 4191) and steroid avoidance (n = 1492). Kaplan-Meier curves censored at 10 y were generated for recipient and allograft survival by steroid maintenance. Predictors for recipient and graft survival were examined using Cox Proportional Hazards. Models were adjusted for age, body mass index, ethnicity, diabetes type, human leukocyte-antigen mismatches, cold ischemia time, transplant era, preemptive transplantation, and pancreas donor risk index with the transplant center included as a random effect.
Steroid avoidance gained popularity over time, accounting for over one-fourth of the studied cohort. One-year acute rejection rates by steroid avoidance were comparable for kidney (8.6% versus 9%, P = 0.783); however, the pancreas rejection rate was lower in the steroid avoidance group (7.9% versus 10%; P = 0.035). After adjustment, steroid avoidance did not influence recipient survival (lower level of confidence interval, adjusted hazard ratio, upper level of confidence interval: 0.94, 1.15, 1.39), pancreas (0.75, 0.93, 1.16), or kidney (0.95, 1.18, 1.45) death-censored survival, compared with steroid maintenance.
Accounting for the recipient and graft characteristics, steroid avoidance is associated with similar recipient, pancreas, and kidney graft outcomes compared with steroid maintenance in SPK recipients after antithymocyte globulin induction with tacrolimus and mycophenolate maintenance.
肾移植中避免使用类固醇已被证明具有非劣效性。关于同期胰肾联合移植（SPK）中避免使用类固醇的长期结果数据仍然很少。
利用2000年至2020年的移植受者科学登记系统，我们研究了所有初次交叉配型阴性的SPK受者（N = 5683），这些受者接受了抗胸腺细胞球蛋白诱导治疗，并在使用他克莫司和霉酚酸酯±类固醇维持治疗的情况下，移植肾有功能且存活出院。根据是否使用类固醇将受者分为两组：类固醇维持组（n = 4191）和类固醇避免组（n = 1492）。通过类固醇维持治疗生成10年截尾的Kaplan-Meier曲线，以评估受者和移植肾的存活率。使用Cox比例风险模型检查受者和移植肾存活的预测因素。模型针对年龄、体重指数、种族、糖尿病类型、人类白细胞抗原错配数、冷缺血时间、移植时代、抢先移植以及胰腺供体风险指数进行了调整，并将移植中心作为随机效应纳入。
随着时间的推移，避免使用类固醇的情况越来越普遍，占研究队列的四分之一以上。避免使用类固醇的组中，肾的1年急性排斥率相当（8.6%对9%，P = 0.783）；然而，避免使用类固醇组的胰腺排斥率较低（7.9%对10%；P = 0.035）。调整后，与类固醇维持组相比，避免使用类固醇并不影响受者存活率（置信区间下限、调整后的风险比、置信区间上限：0.94，1.15，1.39）、胰腺（0.75，0.93，1.16）或肾（0.95，1.18，1.45）的死亡截尾存活率。
考虑到受者和移植肾的特征，在接受抗胸腺细胞球蛋白诱导、他克莫司和霉酚酸酯维持治疗的SPK受者中，与类固醇维持治疗相比，避免使用类固醇与相似的受者、胰腺和肾移植结果相关。
