Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain.
Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Transpl Int. 2024 Apr 17;37:12591. doi: 10.3389/ti.2024.12591. eCollection 2024.
Tacrolimus is pivotal in pancreas transplants but poses challenges in maintaining optimal levels due to recipient differences. This study aimed to explore the utility of time spent below the therapeutic range and intrapatient variability in predicting rejection and donor-specific antibody (dnDSA) development in pancreas graft recipients. This retrospective unicentric study included adult pancreas transplant recipients between January 2006 and July 2020. Recorded variables included demographics, immunosuppression details, HLA matching, biopsy results, dnDSA development, and clinical parameters. Statistical analysis included ROC curves, sensitivity, specificity, and predictive values. A total of 131 patients were included. Those with biopsy-proven acute rejection (BPAR, 12.2%) had more time (39.9% ± 24% vs. 25.72% ± 21.57%, = 0.016) and tests (41.95% ± 13.57% vs. 29.96% ± 17.33%, = 0.009) below therapeutic range. Specific cutoffs of 31.5% for time and 34% for tests below the therapeutic range showed a high negative predictive value for BPAR (93.98% and 93.1%, respectively). Similarly, patients with more than 34% of tests below the therapeutic range were associated with dnDSA appearance (38.9% vs. 9.4%, = 0.012; OR 6.135, 1.346-27.78). In pancreas transplantation, maintaining optimal tacrolimus levels is crucial. Suboptimal test percentages below the therapeutic range prove valuable in identifying acute graft rejection risk.
他克莫司在胰腺移植中至关重要，但由于受者的差异，维持最佳水平具有挑战性。本研究旨在探讨治疗窗以下时间和患者内变异性在预测胰腺移植物受者排斥反应和供体特异性抗体（dnDSA）发展中的作用。这项回顾性单中心研究纳入了 2006 年 1 月至 2020 年 7 月期间的成年胰腺移植受者。记录的变量包括人口统计学、免疫抑制细节、HLA 匹配、活检结果、dnDSA 发展和临床参数。统计分析包括 ROC 曲线、敏感性、特异性和预测值。共纳入 131 例患者。活检证实为急性排斥反应（BPAR，12.2%）的患者有更多的时间（39.9%±24%比 25.72%±21.57%， = 0.016）和测试（41.95%±13.57%比 29.96%±17.33%， = 0.009）低于治疗范围。时间和测试低于治疗范围的特定截止值为 31.5%和 34%，BPAR 的阴性预测值较高（分别为 93.98%和 93.1%）。同样，有超过 34%的测试低于治疗范围的患者与 dnDSA 出现相关（38.9%比 9.4%， = 0.012；OR 6.135，1.346-27.78）。在胰腺移植中，维持最佳他克莫司水平至关重要。低于治疗范围的测试百分比不理想可有效识别急性移植物排斥反应风险。
