Floege Jürgen
Division of Nephrology and Immunology, University of Aachen, Aachen, Germany.
Semin Nephrol. 2004 May;24(3):287-91. doi: 10.1016/j.semnephrol.2004.01.008.
Recurrence of the original disease is now the third most frequent cause of allograft loss at 10 years after transplantation in patients with underlying glomerulonephritis. IgA nephropathy (IgAN), the most common type of glomerulonephritis, histologically recurs in up to 60% of the patients. Initially considered to be a relatively benign phenomenon, several studies, which included a total of almost 1200 patients with underlying IgAN, have now established that after a mean follow up of 5 years, approximately 13% of the patients will exhibit some recurrence-related renal graft dysfunction and approximately 5% will have lost their graft as a result of recurrent IgAN. The only established predictor of graft loss is the time elapsed since renal transplantation. The risk of recurrence-associated graft loss increases to approximately 25% if a prior graft has already been lost as a result of recurrent IgAN. Whether living, related donor kidneys are at higher risk for recurrence is controversial. Despite all these issues, graft survival in patients with underlying IgAN compared with patients with other renal diseases is excellent. In patients with recurrent IgAN, no specific therapy other than optimal supportive care has been established.
对于患有原发性肾小球肾炎的患者,在移植后10年,原发病复发如今是同种异体移植肾丢失的第三大常见原因。IgA肾病(IgAN)是最常见的肾小球肾炎类型,在高达60%的患者中会出现组织学复发。最初被认为是一种相对良性的现象,但包括近1200例原发性IgAN患者的多项研究现已证实,平均随访5年后,约13%的患者会出现一些与复发相关的移植肾功能障碍,约5%的患者会因IgAN复发而失去移植肾。移植肾丢失的唯一已确定的预测因素是肾移植后的时间。如果先前的移植肾已因IgAN复发而丢失,复发相关移植肾丢失的风险会增加到约25%。活体亲属供肾复发风险是否更高存在争议。尽管存在所有这些问题,但与其他肾病患者相比,原发性IgAN患者的移植肾存活率很高。对于IgAN复发的患者,除了最佳支持治疗外,尚未确立其他特异性治疗方法。