Steroids and Recurrent IgA Nephropathy After Kidney Transplantation
Steroids and Recurrent IgA Nephropathy After Kidney Transplantation
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DOI：
10.1111/j.1600-6143.2011.03667.x
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发表时间：
2011-08-01
影响因子：
8.8
通讯作者：
Chadban, S.
中科院分区：
文献类型：
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作者：
Clayton, P.;McDonald, S.;Chadban, S.
我们研究了类固醇使用对复发性IgA肾病（IgAN）引起的肾移植损失的影响。我们使用来自澳大利亚和新西兰透析和移植登记处（ANZDATA）的数据，对1988年至2007年间接受IgAN首次肾移植的成人受者进行生存分析。在一项竞争风险生存分析中，对复发性IgAN导致移植物损失的预测因素进行了分析，并将类固醇使用建模为时变协变量。在研究期间，1521名因活组织检查证实为IgAN而肾衰竭的受者接受了首次肾移植。428名受者经历了移植物损失，其中54例（12.6%）的损失归因于复发性IgAN。复发性IgAN的10年累积移植物损失总发生率为4.3% （95% Cl 3.1-5.8）。类固醇使用率在基线时为92%，1年时为84%，5年时为64%。在调整了年龄、性别、HLA错配、透析时间和移植时间后，类固醇使用与复发风险降低密切相关（亚危险比0.50,95% Cl 0.30-0.84）。这些结果表明，在为IgAN患者量身定制免疫抑制时，应考虑复发性疾病导致移植物损失的风险。
We studied the impact of steroid use on kidney graft loss due to recurrent IgA nephropathy (IgAN). We used data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) to conduct a survival analysis of adult recipients of a first kidney transplant for IgAN who received a graft between 1988 and 2007. Predictors of graft loss due to recurrent IgAN were analyzed in a competing risk survival analysis with steroid use modeled as a time-varying covariate. Fifteen hundred twenty-one recipients with kidney failure due to biopsy-proven IgAN received a first kidney transplant during the study period. Four hundred and twenty-eight recipients experienced graft loss, of which 54 losses (12.6%) were attributed to recurrent IgAN. The overall 10-year cumulative incidence of graft loss from recurrent IgAN was 4.3% (95% Cl 3.1-5.8). Prevalence of steroid use was 92% at baseline, 84% at 1 year and 64% at 5 years. After adjusting for age, sex, HLA mismatch, dialysis duration and transplant era, steroid use was strongly associated with a reduced risk of recurrence (subhazard ratio 0.50, 95% Cl 0.30-0.84). These results suggest that the risk of graft loss from recurrent disease should be considered when tailoring immunosuppression for patients with IgAN.