Moroni Gabriella, Calatroni Marta, Ponticelli Claudio
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy.
Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy.
J Clin Med. 2025 Apr 9;14(8):2592. doi: 10.3390/jcm14082592.
Kidney transplantation is the most effective replacement therapy for kidney failure, providing the best outcomes in terms of patient survival and offering a better quality of life. However, despite the progressive improvement in kidney survival, the recurrence of original disease remains one of the most important causes of graft loss and a major challenge that requires clinical vigilance throughout the transplant's duration. Additionally, the type and severity of recurrence affect both treatment options and graft survival. This is especially true for the recurrence of systemic diseases. In this narrative review, we will discuss the timing, frequency, severity, and treatment of post-transplant recurrence in three systemic diseases: lupus nephritis (LN), Antineutrophil Cytoplasmic Antibodies (ANCA)-associated glomerulonephritis (ANCA-GN), and Henoch-Schönlein purpura (HSP). The recurrence of lupus nephritis is less common than that of primary focal segmental glomerulosclerosis or C3 glomerulopathy. Its severity can range from mild mesangial to diffuse proliferative forms, with varying prognoses and treatment options, much like the original disease. In some patients with LN, as well as in those with ANCA-GN or HSP, the reactivation of the primary disease can affect other organs besides the kidneys, potentially leading to life-threatening conditions. These cases may require a multidisciplinary approach, making these transplants clinically more challenging. Extrarenal flare-ups often necessitate an increase in immunosuppression, which in turn raises the risk of infections. In these autoimmune diseases, the role of immunological tests in determining the timing of kidney transplants remains a topic of ongoing debate. However, elevated levels of certain immunological markers, such as anti-dsDNA antibodies, ANCA titers, or serum immunoglobulin A may indicate a reactivation of the disease, suggesting the need for more intensive patient monitoring.
肾移植是治疗肾衰竭最有效的替代疗法，在患者生存率方面能提供最佳结果，并能改善生活质量。然而，尽管肾存活率在不断提高，但原发病的复发仍然是移植肾丢失的最重要原因之一，也是移植全过程中需要临床密切关注的重大挑战。此外，复发的类型和严重程度会影响治疗方案和移植肾的存活。系统性疾病的复发尤其如此。在这篇叙述性综述中，我们将讨论三种系统性疾病——狼疮性肾炎（LN）、抗中性粒细胞胞浆抗体（ANCA）相关肾小球肾炎（ANCA-GN）和过敏性紫癜（HSP）——移植后复发的时间、频率、严重程度及治疗。狼疮性肾炎的复发比原发性局灶节段性肾小球硬化或C3肾小球病的复发少见。其严重程度可从轻度系膜病变到弥漫性增殖性病变不等，预后和治疗方案各异，与原发病相似。在一些LN患者以及ANCA-GN或HSP患者中，原发病的再激活除了影响肾脏外，还可能累及其他器官， potentially leading to life-threatening conditions. These cases may require a multidisciplinary approach, making these transplants clinically more challenging. Extrarenal flare-ups often necessitate an increase in immunosuppression, which in turn raises the risk of infections. In these autoimmune diseases, the role of immunological tests in determining the timing of kidney transplants remains a topic of ongoing debate. However, elevated levels of certain immunological markers, such as anti-dsDNA antibodies, ANCA titers, or serum immunoglobulin A may indicate a reactivation of the disease, suggesting the need for more intensive patient monitoring. 可能导致危及生命的情况。这些病例可能需要多学科方法，使这些移植在临床上更具挑战性。肾外发作通常需要增加免疫抑制，这反过来又增加了感染风险。在这些自身免疫性疾病中，免疫检测在确定肾移植时机方面的作用仍是一个持续争论的话题。然而，某些免疫标志物水平升高，如抗双链DNA抗体、ANCA滴度或血清免疫球蛋白A，可能表明疾病再激活，提示需要对患者进行更密切的监测。
