Divisione di Nefrologia & Dialisi, Fondazione Ospedale Maggiore, Mangiagalli, Regina Elena, Milan, Italy.
Transpl Int. 2010 Feb;23(2):208-16. doi: 10.1111/j.1432-2277.2009.00977.x. Epub 2009 Sep 30.
Little information is available about the long-term results of kidney transplantation in adults with focal segmental glomerulosclerosis (FSGS). The outcomes of 52 renal transplants performed between 1988 and 2008 in 47 adults with FSGS were compared with those of 104 matched controls (median follow-up 93.4 vs. 109.4 months respectively). At 15 years, patient survival was 100% and graft survival 56% in FSGS patients vs. 88.3% and 64% respectively in controls (P = NS). FSGS recurred in 12 out of 52 grafts (23%) and led to graft failure in seven within 10 months (median). In the other five cases, proteinuria remitted and grafts are functioning 106 months (median) after transplantation. A second recurrence developed in five out of eight re-transplanted patients (62.5%) who lost their first graft because of recurrence; only one graft was lost. Patients with recurrence were more frequently male subjects (83% vs. 40%, P = 0.02), younger at diagnosis of FSGS (16.3 +/- 6.8 vs. 24.1 +/- 11.5 years, P = 0.03) and of younger age at transplantation (28.4 +/- 7.8 vs. 35.8 +/- 12.2 years, P = 0.05). Treatment with plasmapheresis plus ACE inhibitors achieved either complete or partial remission in 80% of the cases. Long-term patient and renal allograft survivals of adults with FSGS were comparable to those of controls. Recurrence was more frequent in young patients and in patients who lost a previous graft from recurrence. Graft loss resulting from a second recurrence is lower than expected.
关于局灶节段性肾小球硬化症 (FSGS) 成人患者的长期肾移植结果，相关信息有限。我们比较了 1988 年至 2008 年间为 47 例 FSGS 成人患者进行的 52 例肾移植与 104 例匹配对照者（分别为中位随访 93.4 和 109.4 个月）的结果。15 年时，FSGS 患者的患者存活率为 100%，移植物存活率为 56%，而对照组分别为 88.3%和 64%（P = NS）。52 例移植物中有 12 例（23%）发生 FSGS 复发，7 例在 10 个月内导致移植物失功（中位）。在其他 5 例中，蛋白尿缓解，移植后 106 个月（中位）时移植物功能正常。5 例因复发而失去首例移植物的再移植患者中有 8 例（62.5%）出现二次复发，仅 1 例移植物失功。复发患者更常见于男性（83%比 40%，P = 0.02），诊断 FSGS 时年龄较小（16.3 +/- 6.8 岁比 24.1 +/- 11.5 岁，P = 0.03），移植时年龄较小（28.4 +/- 7.8 岁比 35.8 +/- 12.2 岁，P = 0.05）。用血浆置换联合 ACEI 治疗使 80%的病例达到完全或部分缓解。FSGS 成人患者的长期患者和肾移植存活率与对照组相当。复发更常见于年轻患者和因复发而失去前一个移植物的患者。因二次复发导致移植物丢失的比例低于预期。
