Role of transplant induction therapy on recurrence rate of focal segmental glomerulosclerosis
Role of transplant induction therapy on recurrence rate of focal segmental glomerulosclerosis
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DOI：
10.1007/s004670050038
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发表时间：
2000-03-01
影响因子：
3
通讯作者：
Diven, S
中科院分区：
文献类型：
--
作者：
Raafat, R;Travis, LB;Diven, S
患有局灶节段性肾小球硬化症（FSGS）的个体在肾移植后有疾病复发的风险。据估计，复发率在 20% 至 30% 之间。与复发概率增加相关的因素尚不清楚，尽管疾病进展的速度、发病年龄以及自体肾脏中弥漫性系膜增殖的存在都与此有关。我们分析了 35 名 FSGS 患者的数据，这些患者于 1968 年 10 月至 1997 年 12 月期间在该机构接受了 37 例肾移植手术。通过出现肾病范围蛋白尿和与诊断相符的移植活检来诊断复发。出现 16 次复发，总复发率为 43%。复发风险与使用抗淋巴细胞血清（ALS）进行初始诱导治疗有关；未接受诱导治疗的患者中这一比例为 11%，而接受 ALS 治疗的患者中为 53%。此外，在后一组中，接受抗胸腺细胞球蛋白 (ATGAM) 治疗的患者的复发率为 88%，而接受明尼苏达抗淋巴细胞球蛋白治疗的患者的复发率为 40%。种族、性别、诊断时的年龄、进展为终末期肾病 (ESRD) 的速度、ESRD 前对烷化剂和/或环孢菌素治疗的反应、移植时的年龄、供体来源以及三重或双重免疫抑制治疗等因素似乎对复发率没有影响。我们的结论是，移植时使用 ALS 诱导治疗会增加肾移植后 FSGS 复发的风险。
Individuals with focal segmental glomerulosclerosis (FSGS) are at risk for recurrence of disease following renal transplantation. The rate of recurrence has been estimated to range from 20% to 30%. The factors associated with an increased probability of recurrence are not known, although the rapidity of progression of disease, age at onset, and the presence of diffuse mesangial proliferation in the native kidney have all been implicated. We analyzed the data from 35 patients with FSGS who received 37 renal transplants at this institution between October 1968 and December 1997. Recurrence was diagnosed by the development of nephrotic-range proteinuria and a transplant biopsy compatible with the diagnosis. Sixteen recurrences were noted, with an overall recurrence rate of 43%. The risk of recurrence was associated with the use of antilymphocytic serum (ALS) for initial induction therapy; being 11% in those who received no induction therapy versus 53% in those who received ALS. Furthermore, in the latter group, the rate of recurrence was 88% in those who received antithymocyte globulin (ATGAM) versus 40% in those who received Minnesota antilymphocytic globulin. Factors such as race, sex, age at time of diagnosis, rapidity of progression to end-stage renal disease (ESRD), response to alkylating agents and/or cyclosporin therapy prior to ESRD, age at time of transplant, donor source, and triple or double immunosuppressive therapy did not appear to have an effect on the rate of recurrence. We conclude that induction therapy with ALS at time of transplantation increases the risk of recurrence of FSGS following renal transplantation.