移植后局灶节段性肾小球硬化的多靶点治疗
Multiple-target Therapy for Posttransplant Focal Segmental Glomerulosclerosis.
作者信息
Mansur Juliana, Chang-Dávila Domingo, Simões Marcela Giraldes, Cristelli Marina Pontello, Stopa Martins Suelen Bianca, de Sousa Proença Henrique Machado, Viana Laila Almeida, Ferreira Alexandra Nicolau, Doher Marisa Petrucelli, Medina-Pestana José, Mastroianni Kirsztajn Gianna, Tedesco-Silva Helio
机构信息
Nephrology Division, Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.
Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
出版信息
Transplant Direct. 2024 May 28;10(6):e1651. doi: 10.1097/TXD.0000000000001651. eCollection 2024 Jun.
BACKGROUND
There is no consensus on the ideal strategy to treat posttransplant focal segmental glomerulosclerosis. The multiple-target therapy, which consisted of high-dose intravenous cyclosporine, prednisone, and plasmapheresis, showed favorable results.
METHODS
This single-center, prospective study sought to evaluate the multiple-target therapy in an independent cohort of patients.
RESULTS
Thirteen patients with posttransplant focal segmental glomerulosclerosis received multiple-target therapy. Complete remission was achieved in 2 patients (15.4%), and partial remission in another 2 patients (15.4%). Four patients (30.7%) did not show remission, and 5 patients (38%) lost the graft because of posttransplant focal segmental glomerulosclerosis during the 12-mo follow-up. Premature discontinuation of treatment occurred in 10 patients (77%), all associated with infectious adverse events. Cytomegalovirus was the most common complication, and preemptive therapy was used instead of prophylaxis.
CONCLUSIONS
In this cohort of patients, the efficacy of the multiple-target therapy was poor and limited by the high incidence of infectious adverse events.
背景
对于移植后局灶节段性肾小球硬化的理想治疗策略尚无共识。由大剂量静脉注射环孢素、泼尼松和血浆置换组成的多靶点治疗显示出良好效果。
方法
这项单中心前瞻性研究旨在评估独立患者队列中的多靶点治疗。
结果
13例移植后局灶节段性肾小球硬化患者接受了多靶点治疗。2例患者（15.4%）实现完全缓解，另外2例患者（15.4%）部分缓解。4例患者（30.7%）未缓解，5例患者（38%）在12个月的随访期间因移植后局灶节段性肾小球硬化而失去移植肾。10例患者（77%）出现治疗提前中断，均与感染性不良事件相关。巨细胞病毒是最常见的并发症，采用抢先治疗而非预防治疗。
结论
在该患者队列中，多靶点治疗的疗效较差，且受感染性不良事件高发生率的限制。
Zotero 插件