PowerPoint Slides for:Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus

Background: This analysis compared efficacy, renal function, and histology in kidney transplant recipients receiving tacrolimus (TAC) combined with everolimus (EVR) or mycophenolate (MPS). Methods: This was a retrospective analysis from a randomized trial in kidney transplant recipients who received a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG), TAC, EVR, and prednisone (PRED; r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. Results: At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 ± 1.05 vs. 0.62 ± 0.75 vs. 0.71 ± 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 ± 20.9 vs. 50.8 ± 19.5 vs. 60.7 ± 21.2 mL/min/1.73 m2, p = 0.017) but comparable using a sensitive analysis (49.5 ± 23 vs. 47.5 ± 22.6 vs. 53.6 ± 27.8 mL/min/1.73 m2, p = 0.207). Conclusion: In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen.背景：本分析对比了接受他克莫司（tacrolimus, TAC）联合依维莫司（everolimus, EVR）或麦考酚酯（mycophenolate, MPS）治疗的肾移植受者的疗效、肾功能及组织学特征。方法：本研究为一项回顾性分析，数据来源于一项针对肾移植受者的随机试验，受试对象接受单次3 mg/kg剂量的兔抗胸腺细胞球蛋白（rabbit antithymocyte globulin, r-ATG）联合他克莫司、依维莫司及泼尼松（prednisone, PRED）治疗（r-ATG/EVR组，n=85），或巴利昔单抗（basiliximab, BAS）联合他克莫司、依维莫司及泼尼松治疗（BAS/EVR组，n=102），或巴利昔单抗联合他克莫司、麦考酚酯及泼尼松治疗（BAS/MPS组，n=101）。本研究评估了12个月时方案活检中新发供者特异性抗人类白细胞抗原抗体（donor-specific anti-human leukocyte antigens antibodies, DSA）的发生率及组织学表现，以及36个月时急性排斥反应发生率、估算肾小球滤过率（estimated glomerular filtration rate, eGFR）与蛋白尿水平。结果：12个月时，三组受试者的新发DSA发生率（6.4% vs. 3.4% vs. 5.5%）、亚临床炎症发生率（2.0% vs. 4.8% vs. 10.2%）、间质纤维化/肾小管萎缩发生率（57.1% vs. 58.5% vs. 53.8%）及C4d沉积发生率（2.0% vs. 7.3% vs. 2.6%）均无统计学显著差异。36个月时，三组受试者的治疗失败发生率（19.0% vs. 27.7% vs. 27.7%, p=0.186）、首次活检证实的急性排斥反应发生率（9.5% vs. 21.8% vs. 16.8%, p=0.073）及尿蛋白/肌酐比值（0.53 ± 1.05 vs. 0.62 ± 0.75 vs. 0.71 ± 1.24）均无统计学显著差异。BAS/EVR组的eGFR水平低于BAS/MPS组（53.4 ± 20.9 vs. 50.8 ± 19.5 vs. 60.7 ± 21.2 mL/min/1.73 m², p=0.017），但采用敏感性分析后组间差异无统计学意义（49.5 ± 23 vs. 47.5 ± 22.6 vs. 53.6 ± 27.8 mL/min/1.73 m², p=0.207）。结论：在本研究队列中，与标准免疫抑制治疗方案相比，采用依维莫司联合低浓度他克莫司的治疗方案在疗效、肾功能及组织学参数方面均表现出相当的效果。