The Failed Renal Transplant: In or Out?
The Failed Renal Transplant: In or Out?
复制标题
肾移植失败：进还是出？
DOI：
10.1111/j.1525-139x.2005.18306.x
复制
发表时间：
2005
影响因子：
1.6
通讯作者：
W. Bennett
中科院分区：
文献类型：
--
作者：
W. Bennett
随着美国进行的肾移植数量的增加，早期和长期同种异体移植失败的数量也在增加。移植失败的患者需要重新进入终末期肾病(ESRD)系统。如果同种异体移植物的发病率很低，在保留同种异体移植物的同时，继续对患者进行低剂量的免疫抑制治疗以避免致敏似乎是合理的。如果同种异体肾提供了足够的肾功能，使患者免于透析，情况尤其如此。然而，如果患者有严重的并发症，可能是由于保留的、失败的肾移植，可能有必要摘除同种移植肾，这通常表现为持续的炎症。这可能会恢复促红细胞生成素的反应性，并有助于患者的整体利益。在这种情况下，撤除免疫抑制的最佳方案还没有被任何科学研究建立，移植肾切除对致敏状态和接受交叉配型阴性再次移植的能力的影响也存在争议。最后介绍了作者的个人做法。
With the increased number of renal transplants being performed in the United States, there are also increasing numbers of early and long‐term allograft failures. Patients with failed allografts require reentry into the end‐stage renal disease (ESRD) system. If an allograft is producing little in the way of morbidity, it seems reasonable to continue the patient on low‐dose immunosuppressive therapy to avoid sensitization while leaving the allograft in. This is particularly true if the allograft is providing enough renal function to keep the patient off dialysis. However, if the patient is having serious morbidity that may be due to the retained, failed kidney transplant, it may be necessary to remove the allograft kidney, which often shows ongoing inflammation. This may restore erythropoietin responsiveness and contribute to the overall benefit of the patient. The optimal protocol for withdrawal of immunosuppression in this circumstance has not been established by any scientific studies, and the effect of allograft nephrectomy on sensitization status and the ability to receive a crossmatch‐negative retransplant are controversial. The author's personal approach is presented.