McDonald Michelle
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Front Nephrol. 2023 Jul 20;3:1169181. doi: 10.3389/fneph.2023.1169181. eCollection 2023.
The role of allograft nephrectomy (AN) in failed renal transplants is a topic of debate, owing to controversial results reported in the literature and the fact that most of the studies are limited by a retrospective design and small numbers of participants. Allograft nephrectomy is most likely of benefit in the patient with recurrent allograft intolerance syndrome (AIS) following pulse steroids. Immunosuppression weaning in the presence of clinical signs related to a chronic inflammatory state is also reasonable grounds to pursue AN. Studies are mainly inconclusive but suggest that AN has no overall benefit for allograft survival after retransplant. This topic is still of interest in the transplant field and is particularly relevant for patients who are likely to require retransplantation within their lifetime. Further assessment is needed in the form of randomized controlled trials that control for various AN indications and immunosuppression regimens, and have clearly defined survival outcomes.
同种异体肾切除术（AN）在肾移植失败中的作用是一个有争议的话题，这是由于文献报道的结果存在争议，而且大多数研究受限于回顾性设计和参与者数量较少。同种异体肾切除术对接受冲击剂量类固醇治疗后出现复发性移植不耐受综合征（AIS）的患者最有可能有益。在存在与慢性炎症状态相关的临床体征时逐渐减少免疫抑制也是进行AN的合理理由。研究主要尚无定论，但表明AN对再次移植后的移植物存活无总体益处。这个话题在移植领域仍然备受关注，对于那些一生中可能需要再次移植的患者尤为重要。需要通过随机对照试验进行进一步评估，这些试验要控制各种AN适应症和免疫抑制方案，并明确界定生存结果。
