Vlachopanos Georgios, Georgalis Argyrios, Gakiopoulou Harikleia
Department of Nephrology, "Asklepieion" General Hospital, Vas. Pavlou Avenue 1, 16673 Athens, Greece.
Department of Transplantation Immunology and Nephrology, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
J Transplant. 2015;2015:639628. doi: 10.1155/2015/639628. Epub 2015 Nov 30.
Background. Posttransplant recurrence of primary focal segmental glomerulosclerosis (rFSGS) in the form of massive proteinuria is not uncommon and has detrimental consequences on renal allograft survival. A putative circulating permeability factor has been implicated in the pathogenesis leading to widespread use of plasma exchange (PLEX). We reviewed published studies to assess the role of PLEX on treatment of rFSGS in adults. Methods. Eligible manuscripts compared PLEX or variants with conventional care for inducing proteinuria remission (PR) in rFSGS and were identified through MEDLINE and reference lists. Data were abstracted in parallel by two reviewers. Results. We detected 6 nonrandomized studies with 117 cases enrolled. In a random effects model, the pooled risk ratio for the composite endpoint of partial or complete PR was 0,38 in favour of PLEX (95% CI: 0,23-0,61). No statistical heterogeneity was observed among included studies (I (2) = 0%, p = 0,42). On average, 9-26 PLEX sessions were performed to achieve PR. Renal allograft loss due to recurrence was lower (range: 0%-67%) in patients treated with PLEX. Conclusion. Notwithstanding the inherent limitations of small, observational trials, PLEX appears to be effective for PR in rFSGS. Additional research is needed to further elucidate its optimal use and impact on long-term allograft survival.
背景。原发性局灶节段性肾小球硬化（rFSGS）移植后以大量蛋白尿形式复发并不罕见，且对肾移植存活有不利影响。一种假定的循环通透性因子被认为与发病机制有关，这导致血浆置换（PLEX）被广泛应用。我们回顾已发表的研究以评估PLEX在成人rFSGS治疗中的作用。方法。通过MEDLINE及参考文献列表确定符合条件的手稿，这些手稿比较了PLEX或其变体与传统治疗在诱导rFSGS蛋白尿缓解（PR）方面的效果。由两名审阅者并行提取数据。结果。我们检测到6项非随机研究，共纳入117例病例。在随机效应模型中，部分或完全PR复合终点的合并风险比为0.38，支持PLEX（95%CI：0.23 - 0.61）。纳入研究中未观察到统计学异质性（I² = 0%，p = 0.42）。平均进行9 - 26次PLEX治疗以实现PR。接受PLEX治疗的患者因复发导致的肾移植丢失率较低（范围：0% - 67%）。结论。尽管小型观察性试验存在固有局限性，但PLEX似乎对rFSGS的PR有效。需要进一步研究以进一步阐明其最佳应用方法及其对长期移植存活的影响。
