Recurrence of IgA nephropathy after kidney transplantation in steroid continuation versus early steroid-withdrawal regimens: a retrospective analysis of the UNOS/OPTN database.
Recurrence of IgA nephropathy after kidney transplantation in steroid continuation versus early steroid-withdrawal regimens: a retrospective analysis of the UNOS/OPTN database.
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DOI：
10.1111/tri.13075
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Pavlakis M
中科院分区：
文献类型：
--
作者：
Leeaphorn N;Garg N;Khankin EV;Cardarelli F;Pavlakis M
在过去的20年里，肾移植中使用类固醇戒断方案的情况有所增加。然而，类固醇戒断可能与复发性伊加肾病（IgAN）的风险增加有关。使用UNOS/OPTN数据，我们分析了2000年至2014年期间接受首次肾移植的IgAN所致ESRD成人患者。对于主要结局，我们使用竞争风险分析比较早期激素停药组（ESW）和激素继续治疗组之间因IgAN复发而导致移植物丢失的累积发生率。次要结局是患者生存率和死亡删失移植物生存率（DCGS）。共纳入9690例受者（ESW组2831例，类固醇持续组6859例）。1238例受体发生移植物丢失，其中191例（15.43%）是由于IgAN复发。在多变量分析中，类固醇使用与复发风险降低相关（子分布风险比0.666，95% CI 0.482-0.921; p=0.014）。两组患者的生存率和DCGS没有差异。在美国，由于IgAN导致的ESRD移植中的ESW与由于疾病复发导致的移植物丢失的风险较高相关。未来的前瞻性研究是必要的，以进一步解决与IgAN患者将受益于类固醇的延续。
In the past 20 years, there has been an increase in use of steroid-withdrawal regimens in kidney transplantation. However, steroid withdrawal may be associated with an increased risk of recurrent IgA nephropathy (IgAN). Using UNOS/OPTN data, we analyzed adult patients with ESRD due to IgAN who received their first kidney transplant between 2000 and 2014. For the primary outcome, we used a competing risk analysis to compare the cumulative incidence of graft loss due to IgAN recurrence between early steroid-withdrawal (ESW) and steroid continuation groups. The secondary outcomes were patient survival and death-censored graft survival (DCGS). A total of 9690 recipients were included (2831 in ESW group and 6859 in steroid continuation group). 1238 recipients experienced graft loss, of which 191 (15.43%) were due to IgAN recurrence. In multivariable analysis, steroid use was associated with a decreased risk of recurrence (subdistribution hazard ratio 0.666, 95% CI 0.482–0.921; p=0.014). Patient survival and DCGS were not different between the two groups. In the U.S., ESW in transplant for ESRD due to IgAN is associated with a higher risk of graft loss due to disease recurrence. Future prospective studies are warranted to further address which patients with IgAN would benefit from steroid continuation.
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