Hruskova Zdenka, Geetha Duvuru, Tesar Vladimir
Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Nephrol Dial Transplant. 2015 Apr;30 Suppl 1:i159-63. doi: 10.1093/ndt/gfu328. Epub 2014 Oct 16.
Despite major advances in the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) achieved in the last decades, a large proportion of AAV patients still develop end-stage renal disease. The survival of AAV patients dependent on dialysis is significantly worse compared with dialysis-independent AAV patients, but is comparable to other non-diabetic patients requiring dialysis. Renal transplantation (RTx) is the method of choice among renal replacement therapies and there has been increasing evidence that it is a suitable method with favorable patient- and graft-survival also in AAV patients. It is recommended to perform RTx after ≥12 months of remission, and ANCA positivity at the time of RTx is generally not considered a contraindication. Even though the risk of relapse after RTx is relatively low with current post-transplant immunosuppressive regimens, disease recurrence may occur. Besides cyclophosphamide, rituximab might become a therapeutic alternative for post-transplant AAV recurrence in the near future but its efficacy and safety in this setting needs to be confirmed in larger studies.
尽管在过去几十年中抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）的治疗取得了重大进展，但仍有很大一部分AAV患者发展为终末期肾病。依赖透析的AAV患者的生存率明显低于不依赖透析的AAV患者，但与其他需要透析的非糖尿病患者相当。肾移植（RTx）是肾脏替代治疗中的首选方法，越来越多的证据表明，对于AAV患者而言，这也是一种具有良好患者和移植物生存率的合适方法。建议在缓解≥12个月后进行RTx，RTx时ANCA阳性通常不被视为禁忌证。尽管目前的移植后免疫抑制方案使RTx后复发的风险相对较低，但疾病仍可能复发。除环磷酰胺外，利妥昔单抗在不久的将来可能成为移植后AAV复发的一种治疗选择，但其在这种情况下的疗效和安全性需要在更大规模的研究中得到证实。
