Phenotype of immunosuppression reduction after kidney transplantation.

Autor: Posadas Salas MA; Division of Nephrology and Hypertension, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA., Taber D; Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA., Soliman K; Division of Nephrology and Hypertension, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA., Nwadike E; Department of Medicine, Lake City Medical Center, Lake City, FL, USA., Srinivas T; Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2020 Oct; Vol. 34 (10), pp. e14047. Date of Electronic Publication: 2020 Aug 06.
DOI: 10.1111/ctr.14047
Abstrakt: Background: Immunosuppressive regimens are delivered without direct measure of the net state of immunosuppression. Besides therapeutic drug monitoring, adjustments in immunosuppressive medications are largely event-driven.
Methods: We studied the clinical phenotype of immunosuppression reduction (ISR) among kidney transplant recipients from 2005 to 2012. Patients were grouped into: no ISR, ISR for infection, or ISR for intolerance. Outcome measures were rejection, rejection-free survival, and IFTA-free survival.
Results: 1114 adult kidney transplant recipients were included: 57% had no ISR, 16% had ISR for infection, and 27% had ISR for intolerance. ISR for infection was mainly on MMF, while ISR for intolerance was mainly on FK. ISR was associated with higher rates of acute rejection. The Kaplan-Meier analysis showed increased prevalence of rejection among patients with ISR due to infection (P = .003) or intolerance (P = .05). The risk of interstitial fibrosis and tubular atrophy was increased in patients with ISR due to infection (P = .001) or intolerance (P = .018).
Conclusion: Immunosuppression reduction is associated with increased prevalence of rejection. The clinical phenotype of ISR is dominated by IFTA remote from the onset of ISR. Solely focusing on acute rejection may underestimate effects of ISR on long-term graft function and survival.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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