Ohta T, Kawaguchi H, Hattori M, Komatsu Y, Akioka Y, Nagata M, Shiraga H, Ito K, Takahashi K, Ishikawa N, Tanabe K, Yamaguchi Y, Ota K
Department of Pediatric Nephrology, Kidney Center, Tokyo Women's Medical University, Japan.
Transplantation. 2001 Mar 15;71(5):628-33. doi: 10.1097/00007890-200103150-00008.
Posttransplant recurrence is frequent in patients who received renal transplantation for focal segmental glomerulosclerosis (FSGS). The recurrence has been ascribed to a circulating permeability factor or factors. We have used plasmapheresis (PP) to treat recurrent FSGS and also studied whether preoperative PP is effective in preventing recurrence of FSGS.
We retrospectively analyzed 21 allografts of 20 patients with nephrotic syndrome and biopsyproven FSGS. They were divided into two groups depending on whether they had prophylactic PP; a prophylactic (n=15) and a nonprophylactic group (n=6). PP was performed two to three times prophylactically and therapeutically until proteinuria was markedly reduced. In each session, 50-75 ml/kg of the patient's plasma was exchanged with 5-8% albumin.
FSGS recurred in 9 of 21 allografts, 4 of 6 in the nonprophylactic group, and 5 of 15 in the prophylactic group. Therapeutic PP was performed in seven of nine recurrent patients without definite adverse effect, with satisfactory results except in one patient. Children lost proteinuria after 6 to > 100 sessions of PP and the number correlated with the pretreatment level of proteinuria. The mean follow-up periods were 62.7 and 41.6 months for the prophylactic and nonprophylactic groups, respectively. At the last follow-up, 66.7% of relapsing and 81.8% of nonrelapsing patients had a functioning graft.
PP appears to be effective for the prevention and treatment of posttransplant recurrence of FSGS, although further consideration of cost/benefit and risks is required before a conclusive judgement can be made.
接受肾移植治疗局灶节段性肾小球硬化症（FSGS）的患者移植后复发很常见。这种复发归因于一种或多种循环通透性因子。我们使用血浆置换（PP）来治疗复发性FSGS，并研究术前PP是否能有效预防FSGS复发。
我们回顾性分析了20例肾病综合征且经活检证实为FSGS患者的21次同种异体移植。根据是否进行预防性PP将他们分为两组；预防性组（n = 15）和非预防性组（n = 6）。预防性和治疗性PP进行两到三次，直到蛋白尿明显减少。在每次治疗中，用5 - 8%的白蛋白置换患者50 - 75 ml/kg的血浆。
21次同种异体移植中有9次发生FSGS复发，非预防性组6次中有4次，预防性组15次中有5次。9例复发患者中有7例进行了治疗性PP，无明确不良反应，除1例患者外结果满意。儿童在进行6至>100次PP后蛋白尿消失，次数与治疗前蛋白尿水平相关。预防性和非预防性组的平均随访期分别为62.7个月和41.6个月。在最后一次随访时，66.7%的复发患者和81.8%的未复发患者移植肾功能良好。
PP似乎对预防和治疗FSGS移植后复发有效，尽管在做出最终判断之前还需要进一步考虑成本/效益和风险。
