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SCI 발표논문

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Sci Rep. 2020;10(1):6425.

Weaning Immunosuppressant in Patients with Failing Kidney Grafts and The Outcomes: A Single-Center Retrospective Cohort Study.

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제1저자 류현진 · 교신저자 이하정

소속 (8)
  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  2. Transplantation Center, Seoul National University Hospital, Seoul, Korea.
  3. Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea.
  4. Departments of Surgery, Seoul National University Hospital, Seoul, Korea.
  5. Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  6. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  7. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. mdhjlee@gmail.com.
  8. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea. mdhjlee@gmail.com.

Abstract

An immunosuppressant weaning protocol in failing allografts has not yet been established. Maintaining immunosuppressants would preserve residual renal function (RRF) and prevent graft intolerance syndrome and sensitization but would increase the risks of infection and malignancy. In this study, graft failure cases after kidney transplantation in a single center were reviewed retrospectively. The outcome differences in all-cause mortality, infection-related hospitalization, cancer, graft intolerance syndrome, re-transplantation, and RRF duration between the immunosuppressant maintaining and weaning groups 6 months after graft failure were compared. Among the weaning group, the outcome differences according to low-dose steroid use were also compared at 6 and 12 months. In a total of 131 graft failure cases, 18 mortalities, 42 infection-related hospitalizations, 22 cancer cases, 11 graft intolerance syndrome cases, and 28 re-transplantations occurred during the 94-month follow-up. Immunosuppressant maintenance significantly decreased the patient survival rate 6 months after graft failure compared with weaning (log-rank P = 0.008) and was an independent risk factor for mortality, even after adjustments (hazard ratio, 3.01; P = 0.025). Infection-related hospitalization, graft intolerance syndrome development, and re-transplantation were not affected by the immunosuppressant weaning protocol. Among the immunosuppressant weaning group, low-dose steroid maintenance at 6 and 12 months helped preserved RRF (P = 0.008 and P = 0.003, respectively).

Figures

Figure 1
Figure 1 Flowsheet of the study population. After the exclusion of these 334 patients, a total of 131 patients were analyzed in this study. Abbreviations. GF, graft failure; KT, kidney transplantation.
Figure 2
Figure 2 Immunosuppressant weaning protocols in the study population. At 6 months after graft failure, immunosuppressant maintained in 22 cases (16.8%) and weaned in 109 cases (83.2%). Among the immunosuppressant weaned cases, low-dose steroid was maintained in 38 cases (29%) and 18 cases (13.8%) at 6 month and 12 month after graft failure, respectively. Abbreviations. ISA, immunosuppressant.
Figure 3
Figure 3 Kaplan-Meier curve of the outcomes in immunosuppressant weaning and maintaining groups 6 months after graft failure. (A) all-cause mortality, (B) hospitalization due to infection, (C) graft intolerance syndrome and (D) re-transplantation. Immunosuppressant maintaining group showed significantly lower survival rates than weaning group (P = 0.008). However, there was no statistically significant difference in infection-related hospitalization (P = 0.914), graft intolerance syndrome (P = 0.445), and re-transplantation (P = 0.838).

그림 출처: PubMed Central 공개 논문 (PMC7156393)

Conflict of interest statement

The authors declare no competing interests.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Scientific reports · eISSN 2045-2322
전자 출판
2020-04-14
MeSH
Adult · Aged · Cohort Studies · Dose-Response Relationship, Drug · Female · Humans · Immunosuppressive Agents / therapeutic use · Kaplan-Meier Estimate · Kidney Failure, Chronic / etiology · Kidney Transplantation / adverse effects · Male · Middle Aged · Steroids / therapeutic use · Treatment Outcome · Young Adult
Substances
Immunosuppressive Agents · Steroids
참고문헌
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