Early post-lung transplant calcineurin inhibitor management varies widely: An international survey.
Early post-lung transplant calcineurin inhibitor management varies widely: An international survey.
复制标题
肺移植后早期钙调神经磷酸酶抑制剂的管理差异很大：一项国际调查。
DOI：
10.1111/ctr.14510
复制
发表时间：
2022
影响因子：
2.1
通讯作者：
Shashaty,MichaelGS
中科院分区：
文献类型：
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作者：
Farrell,ChristineL;Miano,ToddA;Griffiths,Stephen;Christie,JasonD;Diamond,JoshuaM;Shashaty,MichaelGS
钙调神经磷酸酶抑制剂(CNI)是预防肺移植后排斥反应的关键药物，但已知有肾毒性和其他不良反应。1、2移植后早期，受者可能特别容易受到CNI不良反应的影响，如急性肾损伤(AKI)，但数据有限，也没有一致的指导方针来告知剂量、目标水平和相关风险。3因此，我们对临床医生进行了一项匿名的国际调查，宾夕法尼亚大学机构审查委员会免除了对肺移植后头两周CNI实践的调查。从2020年10月至11月，我们通过发布在国际心肺移植学会(ISHLT)肺移植和药房讨论小组和肺移植结果组调查员列表的RedCap网络链接邀请临床医生参与。调查受访者(n=77)主要是来自北美的肺科医生和药剂师(图1A)。他克莫司是73名(94.8%)受访者最初使用的CNI。63例(81.8%)报告使用了诱导剂(55例巴利昔单抗，5例抗胸腺细胞球蛋白，3例阿仑珠单抗)，而14例(18.2%)未使用诱导剂，与ISHLT注册数据相似。4.
Calcineurin inhibitors (CNI) are critical for preventing allograft rejection after lung transplantation, but have known nephrotoxic and other adverse effects. 1, 2 There are limited data and no consensus guidelines to inform dosing, target levels, and associated risks in the early post-transplant period, a timeframe when recipients may be particularly vulnerable to adverse CNI effects such as acute kidney injury (AKI). 3 We therefore conducted an anonymous international survey of clinicians, exempted by the University of Pennsylvania institutional review board, regarding CNI practices during the first 2 weeks after lung transplantation. From October-November 2020, we invited clinicians to participate via REDCap weblink posted to the International Society for Heart and Lung Transplantation (ISHLT) lung transplant and pharmacy discussion groups and the Lung Transplant Outcomes Group investigator listserv.Survey respondents (n= 77) were primarily pulmonologists and pharmacists from North America (Figure 1A). Tacrolimus was the initial CNI used by 73 (94.8%) respondents. Sixty-three (81.8%) reported use of induction agents (55 basiliximab, 5 antithymocyte globulin, 3 alemtuzumab) while 14 (18.2%) used none, similar to ISHLT Registry data. 4