Single-center analysis of early recurrence of nephrotic syndrome following renal transplantation in children.
Single-center analysis of early recurrence of nephrotic syndrome following renal transplantation in children.
复制标题
儿童肾移植术后肾病综合征早期复发的单中心分析
DOI：
10.1034/j.1399-3046.2001.t01-2-00024.x
复制
发表时间：
2001
影响因子：
1.3
通讯作者：
Harmon,WE
中科院分区：
文献类型：
--
作者：
Schachter,AD;Harmon,WE
移植后肾病综合征（NS）的复发发生率为20-50%，中位复发时间为14天，移植物丢失率为50%。我们对1982年至1999年间在波士顿儿童医院接受肾移植的22例小儿NS患者进行了回顾性分析。在Tx后的前14天，13例（59%）患者出现临床复发性肾病综合征（RNS）。50%的活体供体受体和70%的尸体供体受体出现RNS （p=无显著性）。13例RNS患者中有7例接受血浆置换治疗，6例仅接受标准免疫抑制诱导治疗。7名接受治疗的患者中有2名和6名未接受治疗的患者中有1名失去了移植到RNS的移植物，总的RNS移植物失取率为23%。然而，获得缓解的RNS患者的5年累积移植物存活率明显高于未获得缓解的RNS患者（p< 0.001）。两组患者5年的总累积移植存活率无显著差异：非复发性肾病综合征（NRNS）患者为67%，RNS患者为64%，p=无显著性差异。我们得出结论，成功逆转早期RNS可提高儿童RNS移植的长期存活率。迫切需要多中心的研究来开发新的、毒性更低的治疗方法来治疗原发性和复发性NS。
Abstract:Recurrence of nephrotic syndrome (NS) after transplantation (Tx) occurs in 20–50% of renal transplant recipients, with a median time to recurrence of 14 days and a 50% rate of graft loss. We performed a retrospective analysis of 22 pediatric patients with NS who received renal transplants at the Children's Hospital, Boston, between 1982 and 1999. During the first 14 days following Tx, 13 (59%) patients developed clinical recurrent nephrotic syndrome (RNS). RNS developed in 50% of living donor recipients and in 70% of cadaveric donor recipients (p= non‐significant). Seven of the 13 patients with RNS were treated with plasmapheresis, while six received standard immunosuppressive induction therapy only. Two of the seven treated patients and one of the six untreated patients lost their grafts to RNS, yielding a total RNS graft loss rate of 23%. However, patients with RNS who achieved remission had significantly higher cumulative graft survival at 5 yr than did RNS patients who did not achieve remission (p< 0.001). Overall cumulative graft survival at 5 yr was not significantly different between the two groups: 67% in those with non‐recurrent nephrotic syndrome (NRNS) vs. 64% in those with RNS, p= non‐significant. We conclude that successful reversal of early RNS improves long‐term graft survival in pediatric RNS. Multi‐center studies are sorely needed to develop novel, less toxic therapies for native and recurrent NS.