Morales A, Gavela E, Kanter J, Beltrán S, Sancho A, Escudero V, Crespo J, Pallardó L M
Service de Nefrología, Hospital Universitario Dr Peset, Valencia, Spain.
Transplant Proc. 2008 Nov;40(9):2909-11. doi: 10.1016/j.transproceed.2008.09.047.
Among graft failures beyond months, we performed progressive reduction and complete withdrawal of immunosuppressive drugs and steroids over a period of 6 months.
We analyzed the treatment and complications associated with all late allograft failures in 34 patients (8.19%) out of 415 patients transplanted from November 1996 to November 2006.
In 21 patients (61.8%), the progressive reduction of immunosuppressive treatment was effective and well tolerated; however, in 13 patients (38.2%) there was rejection of the allograft at 10.74 +/- 8.95 months (0.77-34.80) after the failure. With the reintroduction of these drugs, the rejection was controlled in seven patients, but in the other six we had to embolize the allograft, which had to be repeated in one case. Embolization was well tolerated, but in one case there was migration of one coil to the femoral artery. One patient treated with drug withdrawal experienced emphysematous pyelonephritis after repeated urinary infections, requiring a nephrectomy. Thirteen (38.2%) of the patients with late failures have been admitted for a second transplant; five of them showed HLA sensitization.
Conservative treatment with progressive withdrawal of immunosuppression was effective and well tolerated in two-thirds of the patients with late renal allograft failure, but one-third of the patients rejected the graft and needed allograft embolization. Infection of the graft and HLA sensitization can complicate the course of these patients.
在移植数月后的移植物失败病例中，我们在6个月的时间里逐步减少并完全停用了免疫抑制药物和类固醇。
我们分析了1996年11月至2006年11月期间415例移植患者中34例（8.19%）所有晚期移植物失败相关的治疗及并发症。
21例患者（61.8%）免疫抑制治疗的逐步减少是有效的且耐受性良好；然而，13例患者（38.2%）在移植物失败后10.74±8.95个月（0.77 - 34.80）出现移植物排斥反应。重新使用这些药物后，7例患者的排斥反应得到控制，但另外6例患者我们不得不对移植物进行栓塞，其中1例需要重复栓塞。栓塞耐受性良好，但1例患者有1个弹簧圈迁移至股动脉。1例接受停药治疗的患者在反复泌尿系统感染后发生气肿性肾盂肾炎，需要进行肾切除术。13例（38.2%）晚期失败患者因再次移植入院；其中5例出现HLA致敏。
对于三分之二的晚期肾移植失败患者，逐步停用免疫抑制药物的保守治疗是有效且耐受性良好的，但三分之一的患者出现移植物排斥反应，需要对移植物进行栓塞。移植物感染和HLA致敏会使这些患者的病程复杂化。
