美国70岁以上患者肾移植后第一年的诱导和维持免疫抑制选择分析

White Amy H, Hunton John, Karim Saleema, Wells Allison, Jensen Hanna, Derringer Darby, Karr Misha, Kumaran Sathyanand, Burdine Lyle
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摘要

在过去的20年里,70岁以上患者的肾移植率稳步上升,然而,适合年龄的老年人免疫抑制方案仍不清楚。研究人员利用SRTR数据库来评估老年肾移植受者与年轻人群的结果。在大约1年的时间间隔内测量移植后的结果包括移植物存活、患者存活、排斥反应、恶性肿瘤和血清肌酐。透析时间少于1年的老年患者生存率提高(95.4%比91.4% p < 0.01)。与其他免疫抑制方案相比,能够维持CNI免疫抑制方案的患者移植物存活率也有所提高(95.5%对91.1%,p < 0.01)。维持mTOR抑制剂治疗的患者生存率最低(85.5%比92.6%,p < 0.01)。诱导治疗的选择不影响患者或移植物的长期生存。这些结果转化为研究人员自己的60岁以上患者中心。SRTR数据库的结果显示,移植前透析时间的最小化改善了移植和患者的生存,而诱导剂的类型对随访时的所有结果影响最小。结果也支持使用CNI和belataccept维持免疫抑制,但不鼓励使用mTOR抑制剂。
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Analysis of induction and maintenance immunosuppression choices in the US during the first year post kidney transplant for patients over 70
Rates of kidney transplantation in patients over 70 years of age have steadily increased over the last 20 years, however age-appropriate immunosuppression regimens in the elderly remain unclear. Investigators utilized the SRTR database to evaluate elderly kidney transplant recipients’ outcomes against a younger population. Post-transplant outcomes measured at an approximately 1-year time interval included graft survival, patient survival, rejection, malignancy, and serum creatinine. Elderly patient survival was improved for those patients that were on dialysis for less than 1 year (95.4% vs. 91.4% p < .01). Patients able to be maintained on CNI immunosuppression regimens also had improved graft survival compared to those managed with other immunosuppression (95.5% vs. 91.1%, p < .01). Patients maintained on mTOR inhibitors had the lowest patient survival (85.5% vs. 92.6%, p < .01). The choice of induction therapy did not affect long term patient or graft survival. These results translated to investigators’ own centers in patients over 60. Results for the SRTR database showed that minimizing time on dialysis prior to transplant improved graft and patient survival, while the type of induction agent had minimal effect on all outcomes at the time of follow-up. The results also support the use of CNI’s and belatacept for maintenance immunosuppression but did not encourage the use of mTOR inhibitors.
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