Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA.
Amyloidosis Center, Boston University School of Medicine, Boston, MA.
Transplantation. 2020 Oct;104(10):2035-2047. doi: 10.1097/TP.0000000000003170.
The present review discusses current developments and outcomes of renal transplantation in systemic amyloidosis. Amyloidosis can wreak havoc on the architecture and functioning of the kidneys, leading to end-stage renal disease. In recent years, the available treatments, especially for light-chain amyloidosis but also for several of the underlying inflammatory diseases that cause amyloid A amyloidosis have expanded leading to prolonged survival albeit frequently with renal failure. At the same time, there are also increasing numbers of patients diagnosed with one of the inherited forms of amyloidosis for which currently there is no targeted treatment available and, in some cases, renal failure is unavoidable. Due to the complex nature of the pathophysiology and treatment of these diseases, it can be very challenging for the clinician to determine whether or not it is appropriate to refer an affected individual for kidney transplantation. Determining eligibility criteria, as well as peritransplant and posttransplant management, requires a multidisciplinary approach with close monitoring and follow-up.
本文综述了系统性淀粉样变患者肾移植的最新进展和结局。淀粉样变可破坏肾脏的结构和功能，导致终末期肾病。近年来，治疗方法，尤其是针对轻链淀粉样变的治疗方法，以及引起淀粉样 A 淀粉样变的一些基础炎症性疾病的治疗方法，都有了进展，患者的生存时间得以延长，但常伴有肾衰竭。与此同时，越来越多的遗传性淀粉样变患者被诊断出来，目前尚无针对这些疾病的靶向治疗方法，在某些情况下，肾衰竭是不可避免的。由于这些疾病的病理生理学和治疗方法复杂，临床医生确定是否适合将受影响的个体转至肾移植科可能具有挑战性。确定资格标准，以及移植前和移植后管理，需要多学科方法，密切监测和随访。
