Delgado Patricia, Diaz Francisco, Gonzalez Ana, Sanchez Emilio, Gutierrez Pedro, Hernandez Domingo, Torres Armando, Lorenzo Victor
University Hospital of Canary Islands, Tenerife, Spain.
Am J Kidney Dis. 2005 Aug;46(2):339-44. doi: 10.1053/j.ajkd.2005.04.024.
Immunologic intolerance to a failed renal allograft left in situ is referred to as graft intolerance syndrome, the incidence and predictors of which are unknown. Treatment by transcatheter vascular embolization has been reported to be less invasive than transplantectomy. The incidence of graft intolerance syndrome and results of transcatheter vascular embolization as a first therapeutic approach were studied.
A retrospective study of 149 transplant recipients who returned to dialysis therapy between June 1989 and December 2001 was performed. After immunosuppression withdrawal, a diagnosis of graft intolerance syndrome was made based on clinical criteria and confirmed by the persistence of renal perfusion under imaging procedures. Potential immunologic predictors were analyzed.
Of 149 patients with failed renal allografts, 55 patients (37%) developed graft intolerance syndrome during follow-up (27.5 +/- 34.5 months; range, 1 to 173 months). Manifestations of graft intolerance syndrome were fever (88%), flu-like symptoms (33%), hematuria (39%), local pain (53%), and increased graft size (51%). Most episodes of graft intolerance syndrome appeared within 6 months (virtually all presented within 24 months after graft failure). None of the immunologic variables studied showed an influence on graft intolerance syndrome. Transcatheter vascular embolization was performed in 48 patients and was successful in 31 patients (65%). A second embolization was necessary in 8 patients. No deaths or severe complications were observed. Eleven patients (22%) underwent transplantectomy because of persistent graft intolerance syndrome (n = 8) or graft infection (n = 3).
Graft intolerance syndrome is common in patients with failed renal allografts left in situ, especially within the first year of returning to dialysis therapy. Our data support transcatheter vascular embolization as first-line therapy for patients with symptomatic failed renal allografts, although 1 in 4 patients will require transplantectomy.
原位留存的移植失败肾发生免疫不耐受被称为移植不耐受综合征，其发病率及预测因素尚不清楚。据报道，经导管血管栓塞治疗比移植肾切除术侵入性小。本研究旨在探讨移植不耐受综合征的发病率以及经导管血管栓塞作为首选治疗方法的效果。
对1989年6月至2001年12月间149例恢复透析治疗的移植受者进行回顾性研究。停用免疫抑制治疗后，根据临床标准诊断移植不耐受综合征，并通过影像学检查证实肾灌注持续存在来确诊。分析潜在的免疫预测因素。
149例移植肾失败患者中，55例（37%）在随访期间（27.5±34.5个月；范围1至173个月）发生移植不耐受综合征。移植不耐受综合征的表现包括发热（88%）、流感样症状（33%）、血尿（39%）、局部疼痛（53%）和移植肾体积增大（51%）。大多数移植不耐受综合征发作发生在6个月内（实际上所有发作均在移植肾失败后24个月内出现）。所研究的免疫变量均未显示对移植不耐受综合征有影响。48例患者接受了经导管血管栓塞治疗，31例（65%）成功。8例患者需要进行第二次栓塞。未观察到死亡或严重并发症。11例患者（22%）因持续性移植不耐受综合征（n = 8）或移植肾感染（n = 3）接受了移植肾切除术。
原位留存的移植失败肾患者中移植不耐受综合征很常见，尤其是在恢复透析治疗的第一年。我们的数据支持将经导管血管栓塞作为有症状的移植失败肾患者的一线治疗方法，尽管四分之一的患者需要进行移植肾切除术。
