早期停用皮质类固醇对胰肾联合移植长期预后的影响：单中心经验及与国际胰腺移植登记处的比较

Impact of early corticosteroid withdrawal on simultaneous pancreas-kidney transplant long-term outcomes: Single center experience and comparison to the International Pancreas Transplant Registry.

作者信息

Pierce Dana R, Gruessner Angelika, Campara Maya, DiCocco Pierpaolo, Spaggiari Mario, Tzvetanov Ivo, Tang Ignatius, Benedetti Enrico, Lichvar Alicia B

机构信息

Department of Pharmacy Practice, University of Illinois Chicago, Chicago, Illinois, USA.

Department of Medicine/Nephrology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.

出版信息

Clin Transplant. 2023 Oct;37(10):e15063. doi: 10.1111/ctr.15063. Epub 2023 Jul 1.

DOI:10.1111/ctr.15063

PMID:37392191

Abstract

BACKGROUND

There remains a paucity of modern data comparing early steroid withdrawal (ESW) versus chronic corticosteroid (CCS) immunosuppression in simultaneous pancreas kidney (SPK) transplant recipients with long-term follow-up. Therefore, the purpose of this study is to assess the effectiveness and tolerability of ESW compared to CCS post-SPK.

METHODS

This was a retrospective single-center matched comparison with the International Pancreas Transplant Registry (IPTR). Patients from University of Illinois Hospital (UIH) represented the ESW group and were compared to those matched CCS patients from the IPTR. Included patients were adult recipients of a primary SPK transplant between 2003 and 2018 within the US receiving rabbit anti-thymocyte globulin induction. Patients were excluded if they had early technical failures, missing IPTR data, graft thrombosis, re-transplant, or positive crossmatch SPK.

RESULTS

A total of 156 patients were matched and included in the analysis. Patients were predominantly African American (46.15%) males (64.1%) with Type 1 diabetes etiology (92.31%). Overall pancreas allograft survival (hazard ratio [HR] = .89, 95% confidence interval [CI] .34-2.30, p = .81) and kidney allograft survival (HR = .80, 95%CI .32-2.03, p = .64) were similar between the two groups. Immunologic pancreas allograft loss was statistically similar at 1-year (ESW 1.3% vs. CCS 0%, p = .16), 5-year (ESW 1.3% vs. CCS 7.7%, p = .16), and 10-year (ESW 11.0% vs. CCS 7.7%, p = .99). The 1-year (ESW 2.6% vs. CCS 0%, p > .05), 5-year (ESW 8.3% vs. CCS 7.0%, p > .05), and 10-year (ESW 22.7% vs. CCS 9.9%, p = .2575) immunologic kidney allograft loss were also statistically similar. There was no difference in 10-year overall patient survival (ESW 76.2% vs. CCS 65.6%, p = .63).

CONCLUSIONS

No differences were found between allograft or patient survival post-SPK when comparing an ESW or CCS protocol. Future assessment is needed to determine differences in metabolic outcomes.

摘要

背景

在接受长期随访的同期胰肾联合移植（SPK）受者中，比较早期停用类固醇（ESW）与长期使用皮质类固醇（CCS）免疫抑制的现代数据仍然很少。因此，本研究的目的是评估与SPK术后的CCS相比，ESW的有效性和耐受性。

方法

这是一项与国际胰腺移植登记处（IPTR）进行的回顾性单中心匹配比较研究。伊利诺伊大学医院（UIH）的患者代表ESW组，并与IPTR中匹配的CCS患者进行比较。纳入的患者是2003年至2018年在美国接受兔抗胸腺细胞球蛋白诱导的原发性SPK移植的成年受者。如果患者有早期技术失败、缺少IPTR数据、移植物血栓形成、再次移植或SPK交叉配型阳性，则排除在外。

结果

共有156例患者匹配并纳入分析。患者主要是非洲裔美国人（46.15%），男性（64.1%），病因是1型糖尿病（92.31%）。两组间总体胰腺同种异体移植物存活率（风险比[HR]=0.89，95%置信区间[CI]0.34 - 2.30，p = 0.81）和肾脏同种异体移植物存活率（HR = 0.80，95%CI 0.32 - 2.03，p = 0.64）相似。免疫性胰腺同种异体移植物丢失在1年（ESW为1.3% vs. CCS为0%，p = 0.16）、5年（ESW为1.3% vs. CCS为7.7%，p = 0.16）和10年（ESW为11.0% vs. CCS为7.7%，p = 0.99）时在统计学上相似。免疫性肾脏同种异体移植物丢失在1年（ESW为2.6% vs. CCS为0%，p > 0.05）、5年（ESW为8.3% vs. CCS为7.0%，p > 0.05）和10年（ESW为22.7% vs. CCS为9.9%，p = 0.2575）时也在统计学上相似。10年总体患者存活率无差异（ESW为76.2% vs. CCS为65.6%，p = 0.63）。