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患者体内免疫抑制变异性对肝移植结局的影响：一项系统评价和荟萃分析。

Impact of Intrapatient Immunosuppression Variability in Liver Transplantation Outcomes: A Systematic Review and Meta-analysis.

作者信息

Lattimore Sherene, Chambers Anastasia, Angeli-Pahim Isabella, Shrestha Abhishek, Eke Benjamin O, Pomputius Ariel, Bylund Carma, Gregory Megan E, Zarrinpar Ali

机构信息

Department of Surgery, University of Florida, Gainesville, FL.

Health Sciences Library, University of Florida, Gainesville, FL.

出版信息

Transplant Direct. 2024 Aug 23;10(9):e1700. doi: 10.1097/TXD.0000000000001700. eCollection 2024 Sep.

DOI:10.1097/TXD.0000000000001700
PMID:39188531
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11346865/
Abstract

BACKGROUND

To investigate the impact of intrapatient variability (IPV) in the levels of immunosuppressant drugs on health outcomes after liver transplantation.

METHODS

A comprehensive systematic review and meta-analysis were conducted, examining literature from MEDLINE/PubMed, Embase, Web of Science, Cochrane Reviews, and Cochrane CENTRAL.

RESULTS

The analysis focused on acute rejection, graft survival, acute kidney injury, and cancer risk as health outcomes. Of 2901 articles screened, 10 met the inclusion criteria. The results indicate a 19% reduction in the risk of acute rejection in patients with lower IPV (RR = 0.81; 95% confidence interval, 0.66-0.99), although 6 studies found no significant association between high IPV and acute rejection. Contrasting results were observed for graft survival, with 1 study indicating worse outcomes for high IPV, whereas another reported no significant difference. High IPV was consistently associated with acute kidney injury across 3 studies. One study suggested a link between high IPV and hepatocellular carcinoma, although a meta-analysis for these outcomes was not feasible.

CONCLUSIONS

These findings point to a marginal but statistically significant association between high IPV and an increased risk of acute rejection, highlighting the importance of precise management of immunosuppressive drugs in liver transplant recipients to enhance patient outcomes.

摘要

背景

探讨肝移植后免疫抑制药物水平的患者内变异性（IPV）对健康结局的影响。

方法

进行了一项全面的系统评价和荟萃分析，检索了MEDLINE/PubMed、Embase、Web of Science、Cochrane综述和Cochrane CENTRAL中的文献。

结果

分析聚焦于急性排斥反应、移植物存活、急性肾损伤和癌症风险等健康结局。在筛选的2901篇文章中，10篇符合纳入标准。结果表明，IPV较低的患者急性排斥反应风险降低19%（风险比=0.81；95%置信区间，0.66-0.99），不过有6项研究发现高IPV与急性排斥反应之间无显著关联。移植物存活方面观察到了相互矛盾的结果，1项研究表明高IPV的结局更差，而另一项研究报告无显著差异。在3项研究中，高IPV始终与急性肾损伤相关。1项研究提示高IPV与肝细胞癌之间存在关联，不过对这些结局进行荟萃分析不可行。

结论

这些发现表明高IPV与急性排斥反应风险增加之间存在微弱但具有统计学意义的关联，凸显了精确管理肝移植受者免疫抑制药物以改善患者结局的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/7cae623a8d99/txd-10-e1700-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/4ae5179e72db/txd-10-e1700-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/2ab41a78073f/txd-10-e1700-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/82d003783df9/txd-10-e1700-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/7cae623a8d99/txd-10-e1700-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/4ae5179e72db/txd-10-e1700-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/2ab41a78073f/txd-10-e1700-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/82d003783df9/txd-10-e1700-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/711b/11346865/7cae623a8d99/txd-10-e1700-g004.jpg

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