Paul L C
Department of Nephrology, Leiden University Medical Center, The Netherlands.
Kidney Int. 1999 Sep;56(3):783-93. doi: 10.1046/j.1523-1755.1999.00611.x.
Chronic allograft nephropathy is the most prevalent cause of renal transplant failure in the first post-transplant decade, but its pathogenesis has remained elusive. Clinically, it is characterized by a slow but variable loss of function, often in combination with proteinuria and hypertension. The histopathology is also not specific, but transplant glomerulopathy and multilayering of the peritubular capillaries are highly characteristic. Several risk factors have been identified, such as advanced donor age, delayed graft function, repeated acute rejection episodes, vascular rejection episodes, and rejections that occur late after transplantation. A common feature of chronic allograft nephropathy is that it develops in grafts that have undergone previous damage, although the mechanism(s) responsible for the progressive fibrosis and tissue remodeling has not yet been defined. Hypotheses to explain chronic allograft nephropathy include the immunolymphatic theory, the cytokine excess theory, the loss of supporting architecture theory, and the premature senescence theory. The most effective option to prevent chronic allograft nephropathy is to avoid graft injury from both immune and nonimmune mechanisms.
慢性移植肾肾病是移植后第一个十年内肾移植失败最常见的原因，但其发病机制仍不清楚。临床上，其特点是功能缓慢但程度不一地丧失，常伴有蛋白尿和高血压。组织病理学表现也不具有特异性，但移植性肾小球病和肾小管周围毛细血管多层化具有高度特征性。已确定了几个危险因素，如供体年龄较大、移植肾功能延迟、反复发生急性排斥反应、血管性排斥反应以及移植后晚期发生的排斥反应。慢性移植肾肾病的一个共同特点是它发生在先前已受损的移植物中，尽管导致进行性纤维化和组织重塑的机制尚未明确。解释慢性移植肾肾病的假说是免疫淋巴理论、细胞因子过剩理论、支持结构丧失理论和过早衰老理论。预防慢性移植肾肾病最有效的方法是避免移植物受到免疫和非免疫机制的损伤。
