Immunosuppression should be stopped in patients with renal allograft failure
Immunosuppression should be stopped in patients with renal allograft failure
复制标题
同种异体肾移植衰竭患者应停止免疫抑制
作者：
P. S. Gregoor;R. Zietse;Jlcm Van Saase;CT Op De Hoek;J. Ijzermans;Atj Lavrijssen;GMTh De Jong;P. Kramer;W. Weimar
肾移植失败后返回血液透析或腹膜透析的患者有时会将肾移植物留在原位以产生一些尿液。低剂量的免疫抑制药物通常在这些患者中继续使用。为了评价接受（A组）或不接受（B组）低剂量维持免疫抑制的患者之间的发病率和死亡率，启动了本研究。在一项多中心队列研究中，我们分析了患者档案中的数据，这些数据显示1972年8月10日至1996年4月4日期间至少3个月移植功能失败，包括197例肾移植。在A组和B组中，每患者年的感染总数分别为1.7例和0.51例（比值比[OR]：3.4，95%置信区间[CI]：2.5-4.5）。与B组相比，A组的死亡率增加（OR 3.4，95% CI：1.8-6.3），均来自感染性疾病（OR 2.8，95% CI：1.1-7.0）和心血管疾病（OR 4.9，95% CI：1.8-13.5）。继续使用免疫抑制药物并没有减少排斥反应（定义为疼痛、触痛的移植物和/或血尿和/或低度非感染性发热）。移植切除术相关的发病率和死亡率可接受。与低剂量维持免疫抑制相关的发病率和死亡率增加支持在肾移植失败患者恢复透析时停用这些药物。
Patients returning to haemodialysis or peritoneal dialysis after a failed kidney transplantation sometimes have a renal allograft left in situ for some urine production. Low‐dose immunosuppressive medication is often continued in such patients. To evaluate the morbidity and mortality between patients in time periods with (group A) or without (group B) low‐dose maintenance immunosuppression, the present study was initiated. In a multi‐centre cohort study we analysed data from patient files, which showed failure after at least 3 months graft function between 10 August 1972 and 4 April 1996, including 197 kidney transplantations. A total of 1.7 versus 0.51 infections per patient year was found in groups A and B, respectively (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 2.5–4.5). There was an increased mortality in group A compared to group B (OR 3.4, 95% CI: 1.8–6.3), both from infectious disease (OR 2.8, 95% CI: 1.1–7.0), and cardiovascular disease (OR 4.9, 95% CI: 1.8–13.5). Continuation of immunosuppressive medication did not lead to fewer rejections (defined as a painful, tender graft and/or haematuria and/or low‐grade non‐infectious fever). Transplantectomy‐related morbidity and mortality were acceptable. The increase in morbidity and mortality associated with low‐dose maintenance immunosuppression argues in favour of stopping these medicaments when failed renal allograft patients return to dialysis.