Borderline rejection after renal transplantation - to treat or not to treat
Borderline rejection after renal transplantation - to treat or not to treat
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DOI：
10.1111/j.1399-0012.2009.01105.x
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发表时间：
2009-12-01
影响因子：
2.1
通讯作者：
Zeier, M.
中科院分区：
文献类型：
--
作者：
Beimler, J.;Zeier, M.
根据同种异体肾移植病理的Baniff分类，边缘性改变定义了不足以诊断急性排斥反应的改变。界线改变与急性同种异体肾移植排斥反应的关系尚不清楚。对出现这种变化的患者进行适当的临床处理是有争议的。亚急性小管炎发病率高的一种可能解释是，这些变化在没有移植物功能障碍的情况下没有后果，强化免疫抑制治疗是不必要的，可能是有害的。另一种观点，与晚期方案活检研究中CAN的高发病率一致，认为免疫抑制已经变得如此强大，以至于血清肌酐升高甚至无法表现出排斥反应。界线变化应作为算法的一部分，但不能作为治疗决策的唯一标准。基于现有研究的微弱证据，在我们的临床边缘性排斥患者中，我们必须权衡个体免疫风险与增加免疫抑制的潜在副作用。即使我们知道大多数有边缘性浸润的病人不会发展成排斥反应。在许多移植中心，边缘性排斥反应的治疗采用额外的类固醇或增强维持免疫抑制。
According to the Baniff classification of renal allograft pathology, the category borderline changes defines changes insufficient for a diagnosis of acute rejection. The relationship between borderline changes and acute renal allograft rejection still remains unclear. The appropriate clinical management for patients showing such changes is controversial. One possible interpretation of the high incidence of subacute tubulitis is that these changes in the absence of graft dysfunction are of no consequence and that treatment with intensified immunosuppression is unnecessary and perhaps harmful. Another view, consistent with the high incidence of CAN in late protocol biopsy Studies, is that immunosuppression has become so powerful, that rejection may not even be manifested by a rising serum creatinine. Borderline changes should be used as part of an algorithm, but not as the only criterion, for therapeutic decision making. Based on the weak evidence of existing studies, in our patients with clinical borderline rejection, we have to weigh the individual immunological risk against the potential side effects of increased immunosuppression. Even in the knowledge that a majority of patients with borderline infiltrates will not progress into rejection. in many transplant centers, borderline rejection is treated with additional steroids or augmentation of maintenance immunosuppression.