Differences in Early Immunosuppressive Therapy Among Liver Retransplantation Recipients in a National Cohort.
Differences in Early Immunosuppressive Therapy Among Liver Retransplantation Recipients in a National Cohort.
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DOI：
10.1097/tp.0000000000003417
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发表时间：
2021-08-01
期刊：
影响因子：
6.2
通讯作者：
Bittermann T
中科院分区：
文献类型：
--
作者：
Mezochow AK;Abt PL;Bittermann T
关于再次肝移植（reLT）后首选的免疫抑制（IS）策略，目前尚无统一的共识。这是一项使用器官共享联合网络数据库的回顾性队列研究。描述了与诱导使用和早期维持IS方案相关的患者、供体和中心特征。多变量考克斯比例风险分析评价了诱导治疗作为reLT后生存率的预测因素。从2002年到2018年，116个中心有3483名成人reLT接受者，其中95.6%在与初始LT相同的中心进行。reLT的时间与诱导IS使用和出院方案相关（两者均为p<0.001），但与reLT后6个月和12个月的方案无关（两者均为p=0.1）。在晚期reLT（>365天）中，初始肝病病因是维持方案比移植物衰竭原因更重要的决定因素。低reLT容量中心更常使用诱导治疗晚期reLT（41.1% vs 22.6%高容量; p=0.002），但在第一年单独停用CNI的可能性较小（19.1% vs 38.7%高容量; p=0.002）。考虑到受体和供体因素，耗竭诱导略微改善了reLT后死亡率（校正HR 0.77，95% CI：0.61-0.99; p=0.08），而非耗竭诱导无显著影响。虽然有几个接收者属性通知早期IS决策，但这并不以统一的方式发生，中心因素也起作用。需要进一步的研究来评估早期IS对reLT后结局的影响。
There is no unified consensus as to the preferred immunosuppression (IS) strategy following liver retransplantation (reLT). This was a retrospective cohort study using the United Network for Organ Sharing database. Recipient, donor and center characteristics associated with induction use and early maintenance IS regimen were described. Multivariable Cox proportional hazards analysis evaluated induction receipt as a predictor of post-reLT survival. There were 3483 adult reLT recipients from 2002–2018 at 116 centers with 95.6% being performed at the same center as the initial LT. Timing of reLT was associated with induction IS use and the discharge regimen (p<0.001 for both), but not with regimens at 6- and 12-months post-reLT (p=0.1 for both). Among late reLTs (>365 days) initial liver disease etiology was a more important determinant of maintenance regimen than graft failure cause. Low reLT volume centers used induction more often for late reLTs (41.1% vs 22.6% high volume; p=0.002), yet less likely to wean to CNI alone in the first year (19.1% vs 38.7% high volume; p=0.002). Accounting for recipient and donor factors, depleting induction marginally improved post-reLT mortality (adjusted HR 0.77, 95% CI: 0.61–0.99; p=0.08), while nondepleting induction had no significant effect. While several recipient attributes inform early IS decision-making, this does not occur in a uniform manner and center factors also play a role. Further studies are needed to assess the effect of early IS on post-reLT outcomes.