Histocompatibility and Immunogenetics Laboratory, Northwest London Pathology NHS Trust, Hammersmith Hospital, London, United Kingdom.
Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom.
Transpl Int. 2023 Jun 2;36:11056. doi: 10.3389/ti.2023.11056. eCollection 2023.
This analysis reports on the outcomes of two different steroid sparing immunosuppression protocols used in the management of 120 highly sensitised patients (HSPs) with cRF>85% receiving Alemtuzumab induction, 53 maintained on tacrolimus (FK) monotherapy and 67 tacrolimus plus mycophenolate mofetil (FK + MMF). There was no difference in the median cRF or mode of sensitisation between the two groups, although the FK + MMF cohort received more poorly matched grafts. There was no difference in one-year patient or allograft survival, however rejection free survival was inferior with FK monotherapy compared with FK + MMF at 65.4% and 91.4% respectively, < 0.01. DSA-free survival was comparable. Whilst there was no difference in rates of BK between the cohorts, CMV-free survival was inferior in the FK + MMF group at 86.0% compared with 98.1% in the FK group, = 0.026. One-year post-transplant diabetes free survival was 89.6% and 100.0% in the FK and FK + MMF group respectively, = 0.027, the difference attributed to the use of prednisolone to treat rejection in the FK cohort, = 0.006. We report good outcomes in HSPs utilising a steroid sparing protocol with Alemtuzumab induction and FK + MMF maintenance and provide granular data on immunological and infectious complications to inform steroid avoidance in these patient groups.
本分析报告介绍了两种不同的类固醇节约型免疫抑制方案在 120 名高致敏患者（HSP）中的应用结果，这些患者的 cRF>85%，接受了 Alemtuzumab 诱导，53 名患者接受了他克莫司（FK）单药治疗，67 名患者接受了 FK+霉酚酸酯（FK+MMF）治疗。两组患者的中位 cRF 或致敏方式无差异，尽管 FK+MMF 组接受了更多配型不佳的移植物。两组患者的一年患者或移植物存活率无差异，但 FK 单药治疗组的无排斥反应存活率明显低于 FK+MMF 组，分别为 65.4%和 91.4%，<0.01。无 DSA 存活率相当。虽然两组患者的 BK 发生率无差异，但 FK+MMF 组的 CMV 无存活率为 86.0%，而 FK 组为 98.1%，=0.026。移植后一年无糖尿病存活率分别为 FK 组 89.6%和 FK+MMF 组 100.0%，=0.027，差异归因于 FK 组使用泼尼松龙治疗排斥反应，=0.006。我们报告了 HSP 患者使用 Alemtuzumab 诱导和 FK+MMF 维持的类固醇节约型方案的良好结果，并提供了免疫和感染并发症的详细数据，为这些患者群体避免使用类固醇提供了依据。
