Steroid maintenance in repeat kidney transplantation: Influence of induction agents on outcomes
| Autor: | Richard J. Marcus, Khaled Nashar, Sabiha M Hussain, Kalathil K Sureshkumar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Adult
Graft Rejection Male Reoperation medicine.medical_specialty Daclizumab Time Factors Tissue and Organ Procurement Recombinant Fusion Proteins medicine.medical_treatment lcsh:Medicine Antibodies Monoclonal Humanized Gastroenterology Drug Administration Schedule Steroid Basiliximab Young Adult Risk Factors Internal medicine medicine Humans Alemtuzumab Kidney transplantation Antilymphocyte Serum business.industry Graft Survival Hazard ratio lcsh:R Antibodies Monoclonal General Medicine Middle Aged medicine.disease Kidney Transplantation Survival Analysis United States Confidence interval Surgery Calcineurin Regimen Organ procurement Treatment Outcome Immunoglobulin G Drug Therapy Combination Female Steroids business Immunosuppressive Agents medicine.drug |
| Zdroj: | Saudi Journal of Kidney Diseases and Transplantation, Vol 25, Iss 4, Pp 741-749 (2014) |
| ISSN: | 1319-2442 |
| Popis: | The influence of steroid maintenance on the outcomes of repeat kidney transplant (RKT) recipients with respect to induction type is unclear. Using the Organ Procurement and Transplant Network/United Network of Organ Sharing (OPTN/UNOS) database, we identified patients (≥18 years) who underwent deceased donor RKT from January 2000 to December 2008 after receiving induction with rabbit-antithymocyte globulin (r-ATG), alemtuzumab or an IL-2 receptor blocker (IL-2B) and were discharged on a calcineurin inhibitor/mycophenolate mofetil regimen with or without steroids. Of 5634 patients, 3643 received r-ATG (steroid = 3157, no-steroid = 486), 448 alemtuzumab (steroid = 196, no-steroid = 252) and 1543 an IL-2B (steroid = 1465, no-steroid = 78). Unadjusted graft survivals were similar for the no-steroid versus steroid groups for induction with r-ATG [hazard ratio (HR) 0.85 and 95% confidence interval (95% CI) 0.70-1.03, P = 0.10], alemtuzumab (HR 0.76, 95% CI 0.51-1.14, P = 0.18) and IL-2B (HR 0.77, 95% CI 0.56-1.70, P = 0.23). In the adjusted model, steroid use improved graft survival in alemtuzumab (HR 0.44, 95% CI 0.25-0.76, P = 0.003) but not in the r-ATG (HR 0.86, 95% CI 0.68-1.09, P = 0.21) or IL-2B (HR 0.98, 95% CI 0.56-1.70, P = 0.94) groups. Steroid use was associated with inferior patient survival in unadjusted (HR 1.30, 95% CI 1.17-1.44, P |
| Databáze: | OpenAIRE |
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