Ảnh hưởng của nồng độ tacrolimus máu đến một số kết cục của thận ghép sau ghép thận một năm

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Tác giả: Thị Việt Hà Đặng, Gia Tuyển Đỗ, Trường Minh Đỗ, Trung Dũng Nghiêm, Tiến Dũng Phạm, Thị Thu Hằng Tống, Phương Lan Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học lâm sàng Bệnh viện Trung ương Huế, 2024

Mô tả vật lý: tr.36-43

Bộ sưu tập: Metadata

ID: 372027

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ABSTRACT THE EFFECT OF TACROLIMUS BLOOD LEVEL ON ALLOGRAFT OUTCOMES ONE YEAR AFTER KIDNEY TRANSPLANTATION Pham Tien Dung1,2, Tong Thi Thu Hang3, Vu Phuong Lan4, Do Gia Tuyen1,2, Dang Thi Viet Ha1,2, Nghiem Trung Dung1, Do Truong Minh1,2 Objective: The study aims to determine the relationship between the characteristics of Tacrolimus trough concentration (C0 TAC) from month 2 to month 12 after kidney transplantation with some clinical outcomes, thereby initially determining the optimal C0 TAC target for patients after kidney transplantation. Methods: A longitudinal retrospective observational study on 257 living - donor kidney transplant patients. Regression analysis was used to evaluate the relationship between mean and coefficient of variation of C0 TAC during the period from 2 months to 12 months after transplantation with clinical outcomes at 12 months post - transplantation, including eGFR, proteinuria, biopsy - proven acute rejection, acute kidney injury, CMV and PCP infection, hospitalization for non - CMV and PCP infections. Results: Patients with mean C0 TAC <
7 ng/ml had the highest risk of eGFR decline and this risk decreased in patients with higher mean C0 TAC, especially in the C0 TAC ≥ 9 ng/ml group (OR = 0.206
p = 0.001
CI 95%: 0.079 - 0.536). Patients with mean C0 TAC 7 - 7.9 ng/ml had a lower risk of acute kidney injury in the first 12 months after transplantation than the group with C0 TAC <
7 ng/ml (OR = 0.234
p = 0.044). The risk of acute rejection in the first 12 months after transplantation tended to decrease in patients with C0 TAC 7 - 7.9 and 8 - 8.9 ng/ml (ORs are respectively 0.612 and 0.25), the difference is not statistically significant. Patients with mean C0 TAC ≥ 9 ng/ml had a higher risk of CMV infection than patients with C0 TAC <
7 ng/ml (OR = 3.737
p = 0.012). The events of acute kidney injury, acute rejection, and hospitalization for non - CMV and PCP infections were more likely to occur in patients with a higher TAC coefficient of variation (ORs are respectively 1.045, 1.049, 1.044 with p = 0.01
0.049 and 0.001). Conclusion: The optimal treatment target of TAC trough level needs to be considered based on different clinical outcomes. A treatment target of 7 - 8.9 ng/ml may be considered for transplant patients during the period from month 2 to month 12 after kidney transplantation.Mục tiêu: Nghiên cứu nhằm xác định mối liên quan giữa đặc điểm nồng độ đáy Tacrolimus (C0 TAC) từ tháng 2 đến tháng 12 sau ghép thận với một số kết cục lâm sàng, từ đó bước đầu xác định đích C0 TAC tối ưu cho bệnh nhân sau ghép thận. Đối tượng, phương pháp: Nghiên cứu quan sát, hồi cứu, theo dõi dọc 257 bệnh nhân ghép thận lần đầu từ người cho sống. Phân tích hồi quy đánh giá mối liên quan giữa trung bình và hệ số biến thiên của C0 TAC trong thời gian sau ghép 2 tháng đến 12 tháng với một số kết cục tại thời điểm sau ghép 12 tháng: mức lọc cầu thận (MLCT), protein niệu, thải ghép cấp, tổn thương thận cấp, nhiễm CMV và PCP, nhập viện vì các nhiễm trùng khác. Kết quả: Bệnh nhân với C0 TAC <
7 ng/ml có nguy cơ suy giảm MLCT cao nhất và nguy cơ này giảm đi ở những bệnh nhân có nồng độ C0 TAC cao, đặc biệt là nhóm C0 TAC ≥ 9 ng/ml (OR = 0.206
p = 0.001
CI 95%: 0.079 - 0.536). Bệnh nhân với C0 TAC 7 - 7.9 ng/ml có nguy cơ tổn thương thận cấp trong 12 tháng đầu sau ghép thấp hơn nhóm có C0 TAC <
7 ng/ml (OR = 0.234
p = 0.044). Nguy cơ thải ghép cấp trong 12 tháng đầu sau ghép có xu hướng giảm ở bệnh nhân có C0 TAC 7 - 7.9 và 8 - 8.9 ng/ml (OR lần lượt là 0.612 và 0.25), sự khác biệt không có ý nghĩa thống kê. Bệnh nhân với C0 TAC ≥ 9 ng/ml có nguy cơ nhiễm CMV cao hơn bệnh nhân có C0 TAC <
7 ng/ml (OR = 3.737
p = 0.012). Các biến cố tổn thương thận cấp, thải ghép cấp và nhập viện vì các nhiễm trùng khác CMV, PCP có nguy cơ cao hơn ở bệnh nhân có hệ số biến thiên TAC cao (OR lần lượt là 1.045, 1.049, 1.044 với p = 0.01
0.049 và 0.001). Kết luận: Đích điều trị C0 TAC tối ưu cần được xem xét dựa trên nhiều biến cố lâm sàng khác nhau. Nồng độ C0 từ 7 - 8.9 ng/ml có thể được cân nhắc cho bệnh nhân sau ghép thận từ 2 tháng đến 12 tháng

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