Mühlbacher Thomas, Amann Kerstin, Mahling Moritz, Nadalin Silvio, Heyne Nils, Guthoff Martina
Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University of Tübingen, Tübingen, Germany.
Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.
Clin Kidney J. 2020 Dec 23;14(6):1691-1693. doi: 10.1093/ckj/sfaa267. eCollection 2021 Jun.
Recurrence of primary focal segmental glomerulosclerosis (FSGS) occurs in up to 50% of patients after kidney transplantation and is associated with poor allograft outcome. Novel therapeutic concepts directly target podocyte function via B7-1 with inconsistent response. We present the case of a 19-year-old patient with recurrent primary FSGS early after living donor kidney transplantation. Plasmapheresis and rituximab did not induce remission. Repetitive abatacept administration was able to achieve partial remission. Maintenance immunosuppression was subsequently switched to a belatacept-based calcineurin inhibitor-free immunosuppression, resulting in sustained complete remission with excellent allograft function throughout a follow-up of >56 months.
原发性局灶节段性肾小球硬化（FSGS）在肾移植术后高达50%的患者中会复发，并与移植肾预后不良相关。新的治疗理念通过B7-1直接靶向足细胞功能，但反应不一。我们报告了一例19岁活体供肾移植术后早期原发性FSGS复发的患者。血浆置换和利妥昔单抗未能诱导缓解。重复给予阿巴西普能够实现部分缓解。随后维持免疫抑制改为基于贝拉西普的无钙调神经磷酸酶抑制剂免疫抑制，在超过56个月的随访中，移植肾功能良好，实现了持续完全缓解。
