Mycophenolate mofetil use is associated with decreased risk of late acute rejection in adult liver transplant recipients
Mycophenolate mofetil use is associated with decreased risk of late acute rejection in adult liver transplant recipients
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DOI：
10.1111/j.1600-6143.2006.01382.x
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发表时间：
2006-07-01
影响因子：
8.8
通讯作者：
Lake, J. R.
中科院分区：
文献类型：
--
作者：
Wiesner, R. H.;Steffen, B. J.;Lake, J. R.
与双药方案相比，霉酚酸酯（MMF）在三药方案中使用可降低急性排斥率。MMF对晚期急性排斥反应（LAR）发作的影响尚未得到很好的描述。为了调查LAR（移植后6个月的排斥反应）的风险，使用了来自移植受者科学登记处（SRTR）的数据。我们研究了1995年6月1日至2004年4月30日期间移植的成人原发性肝移植受者，他们患有丙型肝炎病毒（HCV） （n = 3356），乙型肝炎病毒（HBV） （n = 550）或非病毒性（n = 5740）原发性肝病，记录为在移植后立即连续接受3-（MMF + Tacro +类固醇）或2-药物（Tacro +类固醇）治疗至少6个月。Kaplan-Meier分析显示，移植后4年，丙型肝炎、乙型肝炎和非病毒性疾病患者服用3种药物的LAR发生率明显低于服用2种药物的患者。多因素回归证实，3种药物治疗与2种药物治疗与降低LAR风险相关。移植后6-12个月LAR患者移植后4年晚期移植存活率明显低于早期排斥反应患者（78.0% vs 87.0%, p < 0.001）和无排斥反应患者（88.1%,p < 0.001）。三药治疗与两药治疗至少6个月可能提供更好的治疗策略，以避免LAR发作的后果和费用。
Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described.To investigate the risk of LAR (rejection >= 6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation.Kaplan-Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6-12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001).Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes.