UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center.
UNOS/OPTN Data-guided Assessment of Focal Segmental Glomerulosclerosis After Kidney Transplantation and Evaluation of Immunosuppressive Protocols in a Steroid-free Center.
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DOI：
10.1097/txd.0000000000001196
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发表时间：
2021-09
影响因子：
2.3
通讯作者：
Marsh CL
中科院分区：
文献类型：
--
作者：
Kurian SM;Spierling Bagsic SR;Case J;Barrick BL;Schaffer R;Rice JC;Marsh CL
局灶节段性肾小球硬化（FSGS）是一种常见的复发性肾小球病变，与肾移植（KT）后移植物丢失和患者生存有关。然而，其自然史，临床预测因素和治疗反应仍然知之甚少。KT的类固醇停药方案与心血管风险和患者预后的改善有关。斯克里普斯器官移植中心（SCOT）使用快速低剂量类固醇停药免疫抑制（IS）方案来维持KT。我们评估了我们的方案在10年内对FSGS疾病复发的影响，以重新评估我们的类固醇和IS方案，并评估我们的患者结果是否与已发表的数据不同。我们比较了四组：经常使用类固醇，不使用类固醇，使用类固醇和停用类固醇。我们使用来自器官共享联合网络（UNOS）的IS和诱导匹配的回顾性数据来调查SCOT FSGS患者和移植物的生存情况。我们的分析结果与早期的研究结果不同，早期的研究显示FSGS与更高的移植物丢失风险相关，这可能是因为选择了UNOS数据集来匹配SCOT IS协议进行直接比较。移植失败和受体死亡的总体结果在SCOT患者和来自UNOS FSGS数据的无类固醇移植患者之间没有差异。FSGS的SCOT复发率为7.5%，低于大多数已发表的单中心研究。基于我们的研究结果，我们认为在SCOT继续类固醇避免方案是安全的，当考虑到类固醇使用相关的副作用和毒性时，无类固醇方案可能不是有害的。
Focal segmental glomerulosclerosis (FSGS) is a common recurrent glomerulopathy associated with graft loss and patient survival after kidney transplantation (KT). However, its natural history, clinical predictors, and treatment response are still poorly understood. Steroid withdrawal regimens in KT have been associated with improvements in cardiovascular risk and patient outcomes. The Scripps Center for Organ Transplantation (SCOT) uses a rapid low-dose steroid withdrawal immunosuppression (IS) protocol for KT maintenance. We assessed the impact of our protocol on FSGS disease recurrence over a 10-y period to reassess our steroid and IS protocols and to evaluate if our patient outcomes diverge from published data. We compared 4 groups: steroids always, steroid free, steroid switch on, and steroid weaned off. We used IS and induction-matched retrospective data from United Network for Organ Sharing (UNOS) to investigate patient and graft survival for FSGS at SCOT. Our analysis results differ from earlier studies showing that FSGS was associated with a higher risk of graft loss, perhaps because of selection of a UNOS data set filtered to match the SCOT IS protocol for making direct comparisons. Overall outcomes of graft failure and recipient death did not differ between SCOT patients and steroid-free transplant patient data from the UNOS data for FSGS. SCOT recurrence rate for FSGS was 7.5%, which was lower than in most published single-center studies. Based on our results, we believe that it is safe to continue the steroid avoidance protocols at SCOT and the steroid-free protocol may not be detrimental when the adverse effects and toxicities associated with steroid use are considered.