Gera M, Griffin M D, Specks U, Leung N, Stegall M D, Fervenza F C
Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Kidney Int. 2007 Jun;71(12):1296-301. doi: 10.1038/sj.ki.5002244. Epub 2007 Apr 4.
Progressive glomerulonephritis and attendant end-stage renal disease (ESRD) result from antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The optimum time of kidney transplantation in patients with ESRD due to ANCA-associated vasculitis (AAV) and the risk of renal or nonrenal recurrence of vasculitis after transplantation are unknown. To answer some of these questions, we followed 35 transplant recipients with diagnoses of microscopic polyangiitis (20 patients) and Wegener's granulomatosis (15 patients). The median time from diagnosis to transplantation was 25 months with all patients being in clinical remission. Fifteen patients were ANCA-positive at time of the transplant with 13 preemptive transplants. The most common immunosuppressive strategy included antibody induction, corticosteroid, mycophenolate mofetil, and tacrolimus with acute rejection occurring in eight cases. Overall and death-censored graft survivals were 94 and 100%, respectively, 5 years post-transplantation. Nonrenal relapse occurred in three patients with a satisfactory response to treatment. No clear risk factor to relapse emerged and no detrimental effect to renal function was found. We conclude that transplantation should be considered as the treatment of choice for ESRD due to AAV. Potent antirejection regimes are well tolerated in these patients, are associated with a low risk of recurrence and an absence of AAV-related graft dysfunction.
进行性肾小球肾炎及随之而来的终末期肾病（ESRD）由抗中性粒细胞胞浆抗体（ANCA）相关血管炎引起。因ANCA相关血管炎（AAV）导致ESRD的患者进行肾移植的最佳时机以及移植后血管炎肾复发或非肾复发的风险尚不清楚。为回答其中一些问题，我们对35例诊断为显微镜下多血管炎（20例）和韦格纳肉芽肿（15例）的移植受者进行了随访。从诊断到移植的中位时间为25个月，所有患者均处于临床缓解期。15例患者在移植时ANCA呈阳性，其中13例为抢先移植。最常见的免疫抑制策略包括抗体诱导、皮质类固醇、霉酚酸酯和他克莫司，8例发生急性排斥反应。移植后5年，总体移植物存活率和校正死亡后的移植物存活率分别为94%和100%。3例患者发生非肾复发，治疗反应良好。未发现明确的复发危险因素，也未发现对肾功能有不利影响。我们得出结论，对于因AAV导致的ESRD，应将移植视为首选治疗方法。在这些患者中，强效抗排斥方案耐受性良好，复发风险低，且不存在与AAV相关的移植物功能障碍。
