摘要
AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Sharing database, we compared the adjusted graft and patient survivals for CSM vs early steroid withdrawal(ESW) among patients who underwent deceased-donor kidney(DDK) transplantation from 2000 to 2008 who were stratified by peak-panel reactive antibody(peak-PRA) titers(0%-30%, 31%-60% and > 60%). All patients received perioperative induction therapy and maintenance immunosuppression based on calcineurin inhibitor(CNI) and mycophenolate mofetil(MMF).RESULTS: The study included 42851 patients. In the 0%-30% peak-PRA class, adjusted over-all graft-failure(HR 1.11, 95%CI: 1.03-1.20, P = 0.009) and patientdeath(HR 1.29, 95%CI: 1.16-1.43, P < 0.001) risks were higher and death-censored graft-failure risk(HR 1.06, 95%CI: 0.98-1.14, P = 0.16) similar for CSM(n = 25218) vs ESW(n = 7399). Over-all(HR 1.04, 95%CI: 0.85-1.28, P = 0.70) and death-censored(HR 0.97, 95%CI: 0.78-1.21, P = 0.81) graft-failure risks were similar and patient-death risk(HR 1.39, 95%CI: 1.03-1.87, P = 0.03) higher for CSM(n = 3495) vs ESW(n = 850) groups for 31%-60% peak-PRA class. In the > 60% peak-PRA class, adjusted overall graft-failure(HR 0.90, 95%CI: 0.76-1.08, P = 0.25) and patientdeath(HR 0.92, 95%CI: 0.71-1.17, P = 0.47) risks were similar and death-censored graft-failure risk lower(HR 0.84, 95%CI: 0.71-0.99, P = 0.04) for CSM(n = 4966)vs ESW(n = 923).CONCLUSION: In DDK transplant recipients who underwent perioperative induction and CNI/MMF maintenance, CSM appears to be associated with increased risk for death with functioning graft in minimally-sensitized patients and improved death-censored graft survival in highly-sensitized patients.
AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Sharing database, we compared the adjusted graft and patient survivals for CSM vs early steroid withdrawal(ESW) among patients who underwent deceased-donor kidney(DDK) transplantation from 2000 to 2008 who were stratified by peak-panel reactive antibody(peak-PRA) titers(0%-30%, 31%-60% and > 60%). All patients received perioperative induction therapy and maintenance immunosuppression based on calcineurin inhibitor(CNI) and mycophenolate mofetil(MMF).RESULTS: The study included 42851 patients. In the 0%-30% peak-PRA class, adjusted over-all graft-failure(HR 1.11, 95%CI: 1.03-1.20, P = 0.009) and patientdeath(HR 1.29, 95%CI: 1.16-1.43, P < 0.001) risks were higher and death-censored graft-failure risk(HR 1.06, 95%CI: 0.98-1.14, P = 0.16) similar for CSM(n = 25218) vs ESW(n = 7399). Over-all(HR 1.04, 95%CI: 0.85-1.28, P = 0.70) and death-censored(HR 0.97, 95%CI: 0.78-1.21, P = 0.81) graft-failure risks were similar and patient-death risk(HR 1.39, 95%CI: 1.03-1.87, P = 0.03) higher for CSM(n = 3495) vs ESW(n = 850) groups for 31%-60% peak-PRA class. In the > 60% peak-PRA class, adjusted overall graft-failure(HR 0.90, 95%CI: 0.76-1.08, P = 0.25) and patientdeath(HR 0.92, 95%CI: 0.71-1.17, P = 0.47) risks were similar and death-censored graft-failure risk lower(HR 0.84, 95%CI: 0.71-0.99, P = 0.04) for CSM(n = 4966)vs ESW(n = 923).CONCLUSION: In DDK transplant recipients who underwent perioperative induction and CNI/MMF maintenance, CSM appears to be associated with increased risk for death with functioning graft in minimally-sensitized patients and improved death-censored graft survival in highly-sensitized patients.
基金
supported in part by Health Resources and Services Administration contract 231-00-0115
