Department of Nephrology, University of Florence, Florence, Italy.
J Nephrol. 2012 Nov-Dec;25(6):890-9. doi: 10.5301/jn.5000207.
This review covers the issue of kidney retransplantation. Patients waiting for a second transplant are increasing in number, and it is more and more difficult to find a suitable kidney. The main reasons are both clinical and immunological. Immunological problems are the most difficult to overcome. New techniques allow the identification of anti-HLA antibodies previously not easy to find. As a consequence, patients waiting for a new transplant are often hyperimmunized, and the cross-match is often positive. The authors discuss several immunosuppressive approaches for such patients and new allocation criteria to allow an easier retransplant. New allocation programs such as acceptable mismatch programs and paired kidney exchange programs are being implemented, and new drugs are now emerging allowing new desensitization criteria. Some of them are not yet on the market, but preliminary clinical studies show such drugs to be promising in a short time.
这篇综述涵盖了肾移植再移植的问题。等待二次移植的患者数量不断增加，找到合适的肾脏越来越困难。主要原因既有临床的也有免疫的。免疫问题是最难克服的。新技术使得以前不容易发现的抗 HLA 抗体得以识别。结果，等待新移植的患者往往处于高免疫状态，交叉配型往往呈阳性。作者讨论了几种针对此类患者的免疫抑制方法和新的分配标准，以实现更轻松的再移植。正在实施新的分配方案，如可接受的错配方案和配对肾脏交换方案，新的药物也正在出现，从而允许新的脱敏标准。其中一些尚未上市，但初步临床研究表明，这些药物在短期内有很大的希望。
