Matalon A, Markowitz G S, Joseph R E, Cohen D J, Saal S D, Kaplan B, D'Agati V D, Appel G B
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, 10032, USA.
Clin Nephrol. 2001 Oct;56(4):271-8.
Plasmapheresis (PP) is often employed in the treatment of recurrent focal segmental glomerulosclerosis (FSGS) in the renal allograft, where it appears to be effective in the pediatric population. The efficacy of PP in adults and predictors of response are not well documented. We analyzed the records of 13 adult patients from three transplant centers who underwent PP for recurrent FSGS between 1993 and 1999. One patient (8%) had a complete response, one (8%) had a partial response, and 3 (23%) partially responded but remain PP-dependent. All 5 responders were started on PP within 30 days of recurrence, while 7 of the 8 non-responders initiated PP after a delay of at least 42 days (p = 0.0047). FSGS recurred within 30 days of transplantation in all 5 responders, while 4 of 8 non-responders had no evidence of recurrence until 42-150 days after transplantation (p = 0.098). Post-transplant biopsies were examined in 10 patients and revealed either cellular (6) or collapsing (4) variants of FSGS. We conclude PP is less effective in adults than in children as a treatment for recurrent FSGS in the renal allograft. Predictors of response to PP include early initiation of treatment after recurrence and possibly an early recurrence of disease.
血浆置换术（PP）常用于治疗肾移植中复发性局灶节段性肾小球硬化症（FSGS），在儿科人群中似乎有效。PP在成人中的疗效及反应预测因素尚无充分记录。我们分析了1993年至1999年间来自三个移植中心的13例接受PP治疗复发性FSGS的成年患者的记录。1例患者（8%）完全缓解，1例（8%）部分缓解，3例（23%）部分缓解但仍依赖PP治疗。所有5例有反应的患者在复发后30天内开始接受PP治疗，而8例无反应患者中有7例在至少延迟42天后才开始PP治疗（p = 0.0047）。所有5例有反应的患者在移植后30天内FSGS复发，而8例无反应患者中有4例在移植后42 - 150天内无复发迹象（p = 0.098）。对10例患者进行了移植后活检，结果显示为FSGS的细胞型（6例）或塌陷型（4例）。我们得出结论，作为肾移植中复发性FSGS的一种治疗方法，PP在成人中的效果不如儿童。对PP反应的预测因素包括复发后早期开始治疗以及可能的疾病早期复发。
