Topical administration of tacrolimus and corticosteroids in tapering doses is effective in preventing immune rejection in high-risk keratoplasty: a 5-year follow-up study.
Topical administration of tacrolimus and corticosteroids in tapering doses is effective in preventing immune rejection in high-risk keratoplasty: a 5-year follow-up study.
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逐渐减少剂量的他克莫司和皮质类固醇的局部给药可有效预防高风险角膜移植术中的免疫排斥反应：一项为期 5 年的随访研究
DOI：
10.1186/s12886-022-02318-w
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发表时间：
2022-03-04
影响因子：
2
通讯作者：
Gao H
中科院分区：
文献类型：
--
作者：
Qi X;Wang L;Zhang X;Liu M;Gao H
目的：评价局部应用免疫抑制剂和皮质类固醇逐渐减少剂量对高危角膜移植患者的疗效。106名接受局部免疫抑制剂(FK506组50只眼，CsA组56只眼)和皮质类固醇滴眼液逐渐减少剂量的患者参加了这项研究。评价排斥反应发生率、不可逆排斥反应、移植物存活率及相关影响因素。随访36~60个月，平均48.1月± 7.9月。FK506组排斥反应发生率为14.0%，不可逆性排斥反应发生率为6.00%；CsA组排斥反应发生率为37.5%，不可逆排斥反应发生率为7.1%。经Kaplan-Meier生存分析，术后3、5年FK506组的移植物存活率(81.6%±5.3%、71.1%±6.3%)明显高于CsA组(71.1%±6.3%、57.5%±7.5%)(P = 0.006)。多因素Logistic回归分析显示，术前风险评分 ≥ 3(P = 0.016)和内皮免疫排斥反应(P = 0.033)是影响移植物存活的危险因素。局部应用他克莫司和皮质类固醇，逐渐减少高危角膜移植的免疫排斥反应的发生率。仔细指导患者合理使用外用他克莫司是避免突然停药引起免疫排斥反应的关键。
To evaluate the efficacy of the topical administration of immunosuppressants and corticosteroids in tapering doses in the management of patients with high-risk keratoplasty. One hundred and six patients treated with topical immunosuppressants (50 eyes in the FK506 group and 56 eyes in the CsA group) and corticosteroid eye drops in tapering doses were enrolled in the study. The rates of rejection episodes, irreversible rejection, graft survival, and related influential factors were evaluated. The mean follow-up period was 48.1 ± 7.9 months (range, 36–60 months). The rates of rejection episodes and irreversible rejection were 14.0% and 6.00% in the FK506 group and 37.5% and 7.1% in the CsA group, respectively. Kaplan-Meier survival analysis demonstrated a significantly higher graft survival rate in the FK506 group (81.6%±5.3%, 71.1%±6.3%) compared with that in the CsA group (71.1%±6.3%, 57.5%±7.5%) at 3 and 5 years after surgery (P = 0.006). Multivariate logistic regression revealed that preoperative risk score ≥ 3 (P = 0.016) and endothelial immune rejection (P = 0.033) were risk factors associated with graft survival. Topical administration of tacrolimus and corticosteroids in tapering doses is effective in decreasing the incidence of immune rejection in high-risk keratoplasty. Careful instruction of patients on the reasonable use of topical tacrolimus is critical to avoid immune rejection induced by sudden discontinuation of medication.
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影响因子：
2.8
作者：
Epstein, Andrew J.;de Castro, Terla N.;Rapuano, Christopher J.
通讯作者：
Rapuano, Christopher J.
影响因子：
0.9
作者：
Jabbehdari S;Rafii AB;Yazdanpanah G;Hamrah P;Holland EJ;Djalilian AR
通讯作者：
Djalilian AR
影响因子：
2.8
作者：
Randleman, JB;Stulting, RD
通讯作者：
Stulting, RD
影响因子：
2.8
作者：
Kharod-Dholakia, Bhairavi;Randleman, J. Bradley;Stulting, R. Doyle
通讯作者：
Stulting, R. Doyle
影响因子：
2.8
作者：
Ghaffari, Reza;Ghassemi, Hamed;Djalilian, Ali R.
通讯作者：
Djalilian, Ali R.