UNOS/OPTN data guided assessment of IgA nephropathy recurrence after kidney transplantation and evaluation of immunosuppressive protocols in a steroid free center

Q4 Medicine Transplantation Reports Pub Date : 2020-12-01 DOI:10.1016/j.tpr.2020.100063

Sunil M. Kurian , Samantha R. Spierling Bagsic , Jamie Case , Bethany L. Barrick , Randolph Schaffer , James C. Rice , Christopher L. Marsh

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引用次数: 2

Abstract

Immunoglobulin A (IgA) Nephropathy (IgAN) is one of the most common recurrent glomerulopathies associated with graft loss and patient survival after kidney transplantation (KT). Steroid withdrawal regimens in KT have been associated with improvements of patient outcomes. The Scripps Center for Organ Transplantation (SCOT) utilizes a rapid low-dose steroid withdrawal immunosuppression (IS) protocol for KT maintenance. We assessed the impact of our protocol on IgAN recurrence over a 10-year period to reassess our steroid withdrawal and IS protocols to see if outcomes diverged from available UNOS data. Therefore, we used IS and induction matched retrospective data from UNOS to investigate patient and graft survival for IgAN. SCOT recurrence rates for IgAN was 13.6%. Overall outcomes of graft failure and recipient death did not differ between SCOT patients and data obtained from steroid free transplants from UNOS. Our results differ from earlier studies showing IgAN was associated with a higher risk of graft loss, perhaps due to selection of a SCOT IS matched dataset. Based on our analysis, we believe that it is safe to continue the steroid avoidance protocols at SCOT and think that it may be beneficial, given the adverse effects and toxicities associated with steroid use.

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UNOS/OPTN数据指导肾移植后IgA肾病复发的评估和无类固醇中心免疫抑制方案的评估

免疫球蛋白A (IgA)肾病(IgAN)是最常见的复发性肾小球疾病之一，与肾移植(KT)后移植物丢失和患者生存有关。在KT中，类固醇停药方案与患者预后的改善有关。斯克里普斯器官移植中心(SCOT)采用快速低剂量类固醇戒断免疫抑制(IS)方案来维持KT。我们评估了我们的方案在10年期间对IgAN复发的影响，以重新评估我们的类固醇停药和IS方案，看看结果是否与UNOS现有数据不同。因此，我们使用IS和来自UNOS的诱导匹配的回顾性数据来调查IgAN患者和移植物的生存。IgAN的SCOT复发率为13.6%。移植失败和受体死亡的总体结果在SCOT患者和UNOS无类固醇移植获得的数据之间没有差异。我们的结果与早期的研究不同，早期的研究显示IgAN与更高的移植物丧失风险相关，这可能是由于选择了SCOT IS匹配的数据集。根据我们的分析，我们认为在SCOT继续使用类固醇避免方案是安全的，并且考虑到类固醇使用的副作用和毒性，这可能是有益的。

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来源期刊

Transplantation Reports Medicine-Transplantation

CiteScore

0.60

自引率

0.00%

发文量

审稿时长

101 days

期刊介绍： To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI