Renal transplantation in lupus nephritis
Renal transplantation in lupus nephritis
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DOI：
10.1191/0961203305lu2067oa
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发表时间：
2005-01-01
期刊：
影响因子：
2.6
通讯作者：
Moroni, G
中科院分区：
文献类型：
--
作者：
Ponticelli, C;Moroni, G
大多数系统性红斑狼疮（SLE）患者都是肾移植的合适人选。然而，其中一些可能会出现一些与疾病相关的问题。由于心血管疾病是 SLE 患者发病和死亡的主要原因，因此建议在移植前进行仔细的心血管筛查。寻找抗磷脂抗体也很有用，因为这些抗体的存在可能导致早期移植物血栓形成。移植后 SLE 肾炎复发的风险可能在 2% 至 30% 之间。在大多数情况下，复发的特点是轻微的组织学病变。只有极少数情况下才会导致移植失败。移植后免疫抑制与常规使用的免疫抑制没有什么不同。只要有可能，应安排无类固醇免疫抑制治疗，以防止已接受长期类固醇治疗的患者出现医源性毒性。肾移植的结果很大程度上取决于移植时的临床状况。对于临床状况不佳或正在接受积极免疫抑制的患者，建议推迟移植。当遵守一些选择标准时，SLE 患者的肾移植结果至少与其他移植受者一样好。
Most patients with systemic lupus erythematosus (SLE) are suitable candidates for renal transplantation. However, a number of them may present some disease-related problems. As cardiovascular disease is a leading cause of morbidity and mortality in SLE patients, a careful pretransplant cardiovascular screening is recommended. A search for antiphospholipid antibodies is also useful as the presence of these antibodies can cause an early graft thrombosis. The risk of recurrence of SLE nephritis after transplantation may range between 2 and 30%. In most cases recurrence is characterized by mild histologic lesions. Only rarely does it lead to graft failure. Postransplant immunosuppression does not differ from that used routinely. Whenever possible, a steroid-free immunosuppression should be scheduled to prevent iatrogenic toxicity in patients who have already received long-term steroid treatment. The results of kidney transplantation largely depend on the clinical conditions at transplantation. In patients with poor clinical status or receiving an aggressive immunosuppression it is advisable to postpone the transplant. When some selection criteria are respected, the results of renal trasplantation in SLE patients are at least as good as in other transplant recipients.