肾移植受者免疫抑制治疗的决定因素：一项意大利观察性研究（CESIT 项目）。
Determinants of immunosuppressive therapy in renal transplant recipients: an Italian observational study (the CESIT project).
机构信息
Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
Department of Clinical Sciences, Division of Nephrology, University of Rome La Sapienza, Sant'Andrea University Hospital, Rome, Italy.
出版信息
BMC Nephrol. 2023 Oct 27;24(1):320. doi: 10.1186/s12882-023-03325-9.
BACKGROUND
Very scanty evidence is available on factors influencing the choice of immunosuppressive drug therapy after kidney transplantation.
METHODS
An Italian multiregional real-world study was conducted integrating national transplant information system and claims data. All patients undergoing kidney transplantation for the first time during 2009-2019 (incident patients) were considered. Multilevel logistic models were used to estimate Odds Ratio (OR) and corresponding 95% Confidence intervals. Factors with statistically significance were identified as characteristics associated with treatment regimens: cyclosporin-CsA vs tacrolimus-Tac and, within the latter group, mTOR inhibitors vs mycophenolate-MMF.
RESULTS
We identified 3,622 kidney patients undergoing transplantation in 17 hospitals located in 4 Italian regions, 78.3% was treated with TAC-based therapy, of which 78% and 22% in combination with MMF and mTOR, respectively. For both comparison groups, the choice of immunosuppressive regimens was mostly guided by standard hospital practices. Only few recipient and donor characteristics were found associated with specific regimen (donor/receipt age, immunological risk and diabetes).
CONCLUSIONS
The choice of post-renal transplant immunosuppressive therapy seems to be mostly driven by standard Centre practices, while only partially based on patient's characteristics and recognized international guidelines.
背景
关于影响肾移植后免疫抑制药物治疗选择的因素，现有证据非常有限。
方法
本研究开展了一项意大利多区域真实世界研究，整合了国家移植信息系统和理赔数据。所有在 2009 年至 2019 年期间首次接受肾移植的患者（初治患者）均被纳入研究。采用多水平逻辑回归模型估计比值比（OR）及其相应的 95%置信区间。具有统计学意义的因素被确定为与治疗方案相关的特征：环孢素-CsA 与他克莫司-Tac，以及在后一组中，mTOR 抑制剂与吗替麦考酚酯-MMF。
结果
我们共纳入了来自意大利 4 个地区 17 家医院的 3622 名接受肾移植的患者，78.3%的患者接受 Tac 为基础的治疗方案，其中 78%与 MMF 联合，22%与 mTOR 联合。对于这两个比较组，免疫抑制方案的选择主要受医院标准治疗方案的影响。只有少数受者和供者特征与特定方案相关（供者/受者年龄、免疫风险和糖尿病）。
结论
肾移植后免疫抑制治疗的选择似乎主要受中心标准治疗方案的驱动，而部分基于患者特征和国际公认的指南。
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