Department of Nephrology and Transplantation, Skåne University Hospital, Lund University, Malmö, Sweden.
Transpl Int. 2012 Nov;25(11):1119-28. doi: 10.1111/j.1432-2277.2012.01516.x. Epub 2012 Jun 28.
Despite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge to clinicians, with the potential for over-diagnosis and an inappropriate reduction in immunosuppressive therapy. When graft function is deteriorating, accurately determining the cause of the kidney disease is essential for effective long-term management of the patient. Diagnosis requires a thorough clinical investigation, and in the majority of cases a specific cause can be identified.
尽管随着钙调神经磷酸酶抑制剂（CNI）为基础的免疫抑制治疗的引入，急性排斥反应率显著降低，但肾移植中长期移植物存活率的改善情况喜忧参半。改善长期移植物存活率仍然是肾移植患者管理中的主要挑战。CNIs 是免疫抑制治疗的关键组成部分，慢性 CNI 毒性被广泛认为是晚期移植物失功的一个主要因素。然而，最近详细研究晚期移植物失功原因的研究挑战了这一观点，强调了抗体介导的排斥反应和其他因素的重要性。此外，CNI 肾毒性的诊断对临床医生来说是一个挑战，存在过度诊断和不适当减少免疫抑制治疗的潜在风险。当移植物功能恶化时，准确确定肾脏病的病因对于患者的有效长期管理至关重要。诊断需要进行彻底的临床评估，在大多数情况下可以确定具体病因。
