High tacrolimus intra-patient variability is associated with graft rejection, and de novo donor-specific antibodies occurrence after liver transplantation.
High tacrolimus intra-patient variability is associated with graft rejection, and de novo donor-specific antibodies occurrence after liver transplantation.
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DOI：
10.3748/wjg.v24.i16.1795
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发表时间：
2018-04-28
影响因子：
4.3
通讯作者：
Kamar N
中科院分区：
文献类型：
--
作者：
Del Bello A;Congy-Jolivet N;Danjoux M;Muscari F;Lavayssière L;Esposito L;Hebral AL;Bellière J;Kamar N
研究他克莫司患者内变异性（IPV）在成人肝移植受者中的作用。我们回顾性评估了他克莫司在一组肝移植受者中的变异性，并分析了其对移植物排斥反应和新生供体特异性抗体（dnDSA）发生的影响，以及移植后前2年的移植物存活率。在2015年2月8日至6月期间，纳入了116例接受他克莫司+吗替麦考酚酯（伴或不伴类固醇）治疗的患者。22例患者（18.5%）至少发生了一次急性排斥反应（BPAR）。BPAR的预测因素是他克莫司IPV> 35% [OR = 3.07 95%CI（1.14-8.24），P = 0.03]或> 40% [OR = 4.16（1.38-12.50），P = 0.01），他克莫司谷浓度< 5 ng/mL [OR=3.68（1.3-10.4），P =0.014]。13例患者（11.2%）在随访期间至少发生了一次dnDSA。他克莫司IPV [编码为连续变量：OR = 1.1，95%CI（1.0-1.12），P = 0.006]> 35% [OR = 4.83，95%CI（1.39-16.72），P = 0.01]和> 40% [OR = 9.73，95%CI（2.65-35.76），P = 0.001]被确定为检测dnDSA的预测因素。IPV在随访期间对患者或移植物存活率没有影响。他克莫司-IPV可能是一种有用的工具，用于识别肝移植后移植物排斥反应和新发DSA风险更高的患者
To investigate the role of tacrolimus intra-patient variability (IPV) in adult liver-transplant recipients. We retrospectively assessed tacrolimus variability in a cohort of liver-transplant recipients and analyzed its effect on the occurrence of graft rejection and de novo donor-specific antibodies (dnDSAs), as well as graft survival during the first 2 years posttransplantation. Between 02/08 and 06/2015, 116 patients that received tacrolimus plus mycophenolate mofetil (with or without steroids) were included. Twenty-two patients (18.5%) experienced at least one acute-rejection episode (BPAR). Predictive factors for a BPAR were a tacrolimus IPV of > 35% [OR = 3.07 95%CI (1.14-8.24), P = 0.03] or > 40% [OR = 4.16 (1.38-12.50), P = 0.01), and a tacrolimus trough level of < 5 ng/mL [OR=3.68 (1.3-10.4), P =0.014]. Thirteen patients (11.2%) developed at least one dnDSA during the follow-up. Tacrolimus IPV [coded as a continuous variable: OR = 1.1, 95%CI (1.0-1.12), P = 0.006] of > 35% [OR = 4.83, 95%CI (1.39-16.72), P = 0.01] and > 40% [OR = 9.73, 95%CI (2.65-35.76), P = 0.001] were identified as predictors to detect dnDSAs. IPV did not impact on patient- or graft-survival rates during the follow-up. Tacrolimus-IPV could be a useful tool to identify patients with a greater risk of graft rejection and of developing a de novo DSA after liver transplantation
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影响因子：
4.6
作者：
Supelana, Christina;Annunziato, Rachel A.;Schiano, Thomas D.;Anand, Ravinder;Vaidya, Swapna;Chuang, Kelley;Zack, Yelena;Florman, Sander;Shneider, Benjamin L.;Shemesh, Eyal
通讯作者：
Shemesh, Eyal
影响因子：
9.4
作者：
Mengelle, C;Sandres-Sauné, K;Izopet, J
通讯作者：
Izopet, J
影响因子：
4
作者：
Shuker, Nauras;van Gelder, Teun;Hesselink, Dennis A.
通讯作者：
Hesselink, Dennis A.
DOI：
10.1111/ajt.14276
发表时间：
2017-10
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Shemesh E;Bucuvalas JC;Anand R;Mazariegos GV;Alonso EM;Venick RS;Reyes-Mugica M;Annunziato RA;Shneider BL
通讯作者：
Shneider BL
影响因子：
4.6
作者：
O'Leary, Jacqueline G.;Kaneku, Hugo;Klintmalm, Goeran B.
通讯作者：
Klintmalm, Goeran B.