Division of Nephrology, LSU Health New Orleans and Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70130, USA.
Washington University and St. Louis Children's Hospital, 600 South Euclid Ave, St. Louis, MO, 63110, USA.
Pediatr Nephrol. 2019 Feb;34(2):211-222. doi: 10.1007/s00467-018-3908-4. Epub 2018 Feb 26.
Non-immunologic risk factors are a major obstacle to realizing long-term improvements in kidney allograft survival. A standardized approach to assess donor quality has recently been introduced with the new kidney allocation system in the USA. Delayed graft function and surgical complications are important risk factors for both short- and long-term graft loss. Disease recurrence in the allograft remains a major cause of graft loss in those who fail to respond to therapy. Complications of over immunosuppression including opportunistic infections and malignancy continue to limit graft survival. Alternative immunosuppression strategies are under investigation to limit calcineurin inhibitor toxicity. Finally, recent studies have confirmed long-standing observations of the significant negative impact of a high-risk age window in late adolescence and young adulthood on long-term allograft survival.
非免疫因素是实现肾移植长期存活率提高的主要障碍。美国新的肾脏分配系统最近引入了一种评估供体质量的标准化方法。延迟移植物功能和手术并发症是短期和长期移植物丢失的重要危险因素。在那些对治疗无反应的患者中，移植物疾病复发仍然是移植物丢失的主要原因。过度免疫抑制的并发症，包括机会性感染和恶性肿瘤，继续限制移植物的存活。正在研究替代免疫抑制策略来限制钙调神经磷酸酶抑制剂的毒性。最后，最近的研究证实了长期以来的观察结果，即青春期后期和成年早期的高风险年龄窗口对长期移植物存活有显著的负面影响。
