肾移植和肝移植免疫抑制方案对鼻窦疾病的影响
Impact of kidney and liver transplant immunosuppression regimens on sinonasal disease.
文献信息
| PMID | 42777474 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Robert E Africa |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, 77555, USA. Electronic address: reafrica@utmb.edu. |
| 期刊 | American journal of otolaryngology |
| SCI 分区 | Q2 |
| IF | 1.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 比较肾移植和肝移植患者在接受不同免疫抑制方案后，慢性鼻窦炎伴或不伴鼻息肉（CRSwNP、CRSsNP）、变应性鼻炎（AR）和急性侵袭性真菌性鼻窦炎（IFS）发生率的差异。
方法： 这是一项多中心、回顾性队列研究，使用TriNetX数据库2010年1月1日至2025年7月31日的数据。数据来自美国106家医疗机构。识别成人肾移植和肝移植受者，并按诱导和维持免疫抑制方案进行分层。诱导治疗比较抗胸腺细胞球蛋白（ATG）与巴利昔单抗，维持治疗比较以他克莫司为基础的方案与以环孢素为基础的方案。评估结局和功能性内镜鼻窦手术的发生率。
结果： 与ATG相比，巴利昔单抗诱导治疗后与更高的AR、CRSwNP和急性IFS发生率相关（RR：0.89 [0.82-0.96]；0.62 [0.41-0.93]；0.43 [0.26-0.71]）。在巴利昔单抗治疗组中，针对CRSsNP、CRSwNP和急性IFS的FESS发生率也更高（RR：0.60 [0.43-0.84]；0.70 [0.50-0.96]；0.62 [0.38-0.98]）。与环孢素相比，他克莫司维持治疗与更高的AR和急性IFS发生率相关（RR：1.29 [1.10-1.51]；1.73 [1.17-2.54]）。在接受他克莫司和环孢素维持治疗的患者之间，针对CRSsNP、CRSwNP和急性IFS的手术发生率相似（RR：1.11 [0.60-2.05]；0.89 [0.45-1.71]；1.13 [0.57-2.20]）。
结论： 在比较肾移植和肝移植常用免疫抑制方案时，与ATG相比，巴利昔单抗与更高的鼻窦疾病和AR发生率相关。对于维持免疫抑制，以他克莫司为基础的方案治疗与更高的AR和急性IFS发生率相关。
证据等级： 3级。
英文摘要
OBJECTIVE: To compare differences in the rate of chronic rhinosinusitis with or without nasal polyposis (CRSwNP, CRSsNP), allergic rhinitis (AR), and acute invasive fungal sinusitis (IFS) among kidney and liver transplant patients following different immunosuppression regimens.
METHODS: This is a multicenter, retrospective cohort study utilizing data from the TriNetX database from January 1, 2010 to July 31, 2025. Data are derived from 106 healthcare organizations in the United States. Adult kidney and liver transplant recipients were identified and stratified by induction and maintenance immunosuppression. Induction therapy compared anti-thymocyte globulin (ATG) with basiliximab, and maintenance therapy compared a tacrolimus-based regimen with a cyclosporine-based regimen. Outcomes and rates of functional endoscopic sinus surgery were assessed.
RESULTS: Treatment with basiliximab was associated with a higher rate of AR, CRSwNP, and acute IFS following induction treatment compared to ATG (RR: 0.89 [0.82-0.96]; 0.62 [0.41-0.93]; 0.43 [0.26-0.71]). The rates of FESS to address CRSsNP, CRSwNP, and acute IFS were also higher in group treated with basiliximab (RR: 0.60 [0.43-0.84]; 0.70 [0.50-0.96]; 0.62 [0.38-0.98]). Maintenance therapy with tacrolimus was associated with higher rates of AR and acute IFS compared to cyclosporine (RR: 1.29 [1.10-1.51]; 1.73 [1.17-2.54]). The rates of surgery for CRSsNP, CRSwNP, and acute IFS following maintenance therapy were similar between those treated tacrolimus and cyclosporine (RR: 1.11 [0.60-2.05]; 0.89 [0.45-1.71]; 1.13 [0.57-2.20]).
CONCLUSION: When comparing common immunosuppression for kidney and liver transplant, basiliximab was associated with a higher rate of sinonasal disease and AR compared to ATG. For maintenance immunosuppression, treatment with tacrolimus-based regimens was associated with a higher rate of AR and acute IFS.
LEVEL OF EVIDENCE: Level 3.