Steroid-resistant kidney transplant rejection: diagnosis and treatment.
Steroid-resistant kidney transplant rejection: diagnosis and treatment.
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类固醇抵抗性肾移植排斥反应：诊断和治疗。
DOI：
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发表时间：
2001
影响因子：
13.6
通讯作者：
H. Bock
中科院分区：
文献类型：
--
作者：
H. Bock
移植功能的下降可归因于多种疾病，包括肾前和肾后衰竭、环孢素A（CsA）毒性、多瘤性肾炎、复发性肾小球肾炎和排斥反应。因此，在开始任何治疗之前，应根据足够大小的移植活检来诊断排斥反应。脉冲类固醇治疗（静脉注射3 - 5次0.25- 1.0 g甲基强的松龙脉冲）是通常的一线治疗，成功率为60 - 70%，尽管口服强的松（0.25 g）可能同样有效。即使逆转，任何排斥反应应触发至少暂时增加基础免疫抑制，包括增加CsA或他克莫司的目标水平，增加类固醇或增加其剂量，增加吗替麦考酚酯，或从CsA转换为他克莫司。加入雷帕霉素或其RAD衍生物可以实现相同的目的。类固醇激素抵抗不应假设之前的第五天脉冲类固醇治疗，虽然血管排斥反应的组织学特征可能表明需要更积极的治疗更早。类固醇抵抗性排斥反应传统上用多聚或单克隆抗淋巴细胞抗体治疗，成功率为60%至70%。它们的潜在益处必须与感染和淋巴瘤的风险仔细平衡。最近，霉酚酸酯已被成功地用于治疗类固醇抵抗性排斥反应，但仅限于间质（细胞）型。从CsA转换为他克莫司治疗复发性或抗体抵抗性排斥反应在大约60%的病例中是成功的。血浆置换和静脉注射IG已被用于一些绝望的情况下，取得了令人惊讶的成功。由于没有一种可用的药物具有明显更好的治疗效果与不良反应，因此必须持续平衡持续排斥治疗的可能益处与严重，有时致命的副作用的可能性。
Decreases in transplant function may be attributable to a variety of conditions, including prerenal and postrenal failure, cyclosporin A (CsA) toxicity, polyoma nephritis, recurrent glomerulonephritis, and rejection. The diagnosis of rejection should therefore be made on the basis of a transplant biopsy of adequate size, before the initiation of any therapy. Pulse steroid treatment (three to five 0.25- to 1.0-g pulses of methylprednisolone, administered intravenously) is the usual first-line therapy and has a 60 to 70% success rate, although orally administered prednisone (0.25 g) may be just as efficacious. Even if reverted, any rejection should trigger an at least temporary increase in basal immunosuppression, consisting of an increase in CsA or tacrolimus target levels, the addition of steroids or an increase in their dosage, the addition of mycophenolate mofetil, or a switch from CsA to tacrolimus. The addition of rapamycin or its RAD derivative may fulfill the same purpose. Steroid resistance should not be assumed before the fifth day of pulse steroid treatment, although histologic features of vascular rejection may indicate the need for more aggressive treatment earlier. Steroid-resistant rejection is traditionally treated with poly- or monoclonal antilymphocytic antibodies, with success rates of 60 to 70%. Their potential benefit must be carefully balanced against the risks of infection and lymphoma. More recently, mycophenolate mofetil has been successfully used to treat steroid-resistant rejection, but only of the interstitial (cellular) type. Switching from CsA to tacrolimus for treating recurrent or antibody-resistant rejection is successful in approximately 60% of cases. Plasmapheresis and intravenously administered Ig have been used in some desperate cases, with surprising success. Because none of the available drugs has a significantly better profile of therapeutic versus adverse effects, the possible benefits of continued rejection therapy must be continuously balanced with the potential for serious, sometimes fatal, side effects.
DOI：
10.1073/pnas.080068597
发表时间：
2000-04-11
影响因子：
11.1
作者：
Majewski, M;Korecka, M;Wasik, MA
通讯作者：
Wasik, MA
影响因子：
6.2
作者：
Jordan, SC;Quartel, AW;Tyan, DB
通讯作者：
Tyan, DB
环孢素和他克莫司对 Epstein-Barr 病毒转化的 B 细胞系生长的影响。
影响因子：
6.2
作者：
Beatty,PR;Krams,SM;Esquivel,CO;Martinez,OM
通讯作者：
Martinez,OM