Vinai Modini, Waber Pamela, Seikaly Mouin G
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatr Transplant. 2010 May;14(3):314-25. doi: 10.1111/j.1399-3046.2009.01261.x.
Focal segmental glomerulosclerosis is a major cause of chronic kidney disease requiring transplantation in children. Recurrence rate in the renal allograft transplantation is as high as 50%. Recurrence of FSGS is associated with renal dysfunction and early graft loss. To date, there is no established therapy for recurrent FSGS after renal transplant. We have reviewed the current English literature in order to summarize current practices with emphasis on graft outcome. We conclude that despite multiple approaches to the post transplant management of recurrent FSGS, none have been shown to be consistently beneficial. Currently, pheresis combined with high dose anti-calcineurin with or without rituximab seems to be the most promising. Further controlled studies are needed to define the optimal therapeutic regimens to treat recurrent of FSGS.
局灶节段性肾小球硬化是儿童慢性肾脏病需要进行移植的主要原因。肾移植中同种异体肾移植的复发率高达50%。FSGS的复发与肾功能障碍和移植肾早期丢失相关。迄今为止，对于肾移植后复发性FSGS尚无既定的治疗方法。我们回顾了当前的英文文献，以总结当前的做法，并重点关注移植肾的结局。我们得出结论，尽管对复发性FSGS进行移植后管理有多种方法，但尚无一种方法被证明始终有益。目前，血浆置换联合高剂量抗钙调神经磷酸酶药物，无论有无利妥昔单抗，似乎是最有前景的。需要进一步的对照研究来确定治疗复发性FSGS的最佳治疗方案。
