Early Changes in Kidney Transplant Immunosuppression Regimens During the COVID-19 Pandemic.
Early Changes in Kidney Transplant Immunosuppression Regimens During the COVID-19 Pandemic.
复制标题
DOI：
10.1097/tp.0000000000003502
复制
发表时间：
2021-01-01
期刊：
影响因子：
6.2
通讯作者：
Segev DL
中科院分区：
文献类型：
--
作者：
Bae S;McAdams-DeMarco MA;Massie AB;Ahn JB;Werbel WA;Brennan DC;Lentine KL;Durand CM;Segev DL
由于依赖免疫抑制，肾移植受者患传染病的风险较高。在当前的 COVID-19 大流行期间，一些临床医生可能会选择效力较弱的免疫抑制剂来抵消新型感染风险。我们进行了一项全国性研究，以了解美国 COVID-19 大流行前 5 个月内免疫抑制剂的使用情况和随后的临床结果。利用移植受者科学登记处的数据，我们研究了 2017 年 1 月 1 日至 2020 年 3 月 12 日（“大流行前”时代；n=64 849）和 2020 年 3/13 至 7/31/2020（“大流行”时代；n=5035）期间美国所有仅接受肾脏的受者。我们比较了大流行时期和大流行前时期淋巴细胞消耗剂（与巴利昔单抗或不诱导）和维持类固醇（与类固醇避免/戒断相比）的使用情况。然后，我们比较了大流行期间免疫抑制方案的早期移植后结果。与大流行前的接受者相比，大流行时期的接受者接受淋巴细胞消耗诱导剂的可能性大大降低（aOR = 0.400.530.69）；在州级 COVID-19 发病率、捐赠者类型和接受者年龄的亚组中也发现了类似的趋势。然而，淋巴细胞耗竭诱导剂与入院期间排斥反应减少相关（aOR=0.110.230.47），但与大流行时期死亡率增加无关（aHR=0.130.471.66）。另一方面，维持类固醇的使用与早期类固醇戒断的情况仍然相似（aOR=0.711.071.62）。在 COVID-19 大流行期间，淋巴细胞消耗诱导剂的使用有所减少，转而使用巴利昔单抗，并且没有诱导。然而，这种转变可能导致排斥反应增加，而移植后死亡率并没有明显降低。
Kidney transplant recipients have higher risk of infectious diseases due to their reliance on immunosuppression. During the current COVID-19 pandemic, some clinicians might have opted for less potent immunosuppressive agents to counterbalance the novel infectious risk. We conducted a nationwide study to characterize immunosuppression use and subsequent clinical outcomes during the first 5 months of COVID-19 pandemic in the United States. Using data from the Scientific Registry of Transplant Recipients, we studied all kidney-only recipients in the United States from 1/1/2017 to 3/12/2020 (“prepandemic” era; n=64 849) and from 3/13/2020 to 7/31/2020 (“pandemic” era; n=5035). We compared the use of lymphocyte-depleting agents (vs. basiliximab or no induction) and maintenance steroids (vs. steroid avoidance/withdrawal) in the pandemic era compared to the prepandemic era. Then, we compared early posttransplant outcomes by immunosuppression regimen during the pandemic era. Recipients in the pandemic era were substantially less likely to receive lymphocyte-depleting induction agents compared to their prepandemic counterparts (aOR=0.400.530.69); similar trends were found across subgroups of state-level COVID-19 incidence, donor type, and recipient age. However, lymphocyte-depleting induction agents were associated with decreased rejection during admission (aOR=0.110.230.47), but not with increased mortality in the pandemic era (aHR=0.130.471.66). On the other hand, the use of maintenance steroids versus early steroid withdrawal remained similar (aOR=0.711.071.62). The use of lymphocyte-depleting induction agents has decreased in favor of basiliximab and no induction during the COVID-19 pandemic. However, this shift might have resulted in increases in rejection with no clear reductions in posttransplant mortality.