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首页> 外文期刊>Experimental and clinical transplantation >Clinical Outcomes of Prophylactic and Therapeutic Plasmapheresis in Adult Deceased-Donor Kidney Transplant Recipients With Primary Focal Segmental Glomerulosclerosis
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Clinical Outcomes of Prophylactic and Therapeutic Plasmapheresis in Adult Deceased-Donor Kidney Transplant Recipients With Primary Focal Segmental Glomerulosclerosis

机译：成人原发性肾节段性肾小球硬化死者捐赠肾脏移植的预防性和治疗性血浆置换的临床结果

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Objectives: High recurrence and inferior graft survival rates have been reported for kidney transplant recipients with primary focal segmental glomeru-losclerosis. Plasmapheresis is widely used to treat posttransplant relapsing focal segmental glomer-ulosclerosis, but the effectiveness of prophylactic plasmapheresis remains controversial. Materials and Methods: In this single-center retro-spective study, 21 adult deceased-donor kidney transplant recipients who received prophylactic plasmapheresis were analyzed. Of these, 10 received posttransplant prophylactic plasmapheresis only (less-intensive regimen) and 11 received pre- and posttransplant prophylactic plasmapheresis (more-intensive regimen). Patients with recurrence were treated with steroids and plasmapheresis. Median follow-up was 45 months (interquartile range, 30-107 mo). Results: At last visit, 20/21 patients (95%) were alive and 17/21 (81%) had functioning grafts. Cumulative focal segmental glomerulosclerosis recurrence rate was 38% (8/21): 30% (3/10) in the less-intensive and 45% (5/11) in the more-intensive group (P = .6594). Four of 8 patients (50%) with relapse eventually had graft loss due to recurrence: 100% (3/3) in the less-intensive and 20% (1/5) in the more-intensive group (P = .1429). Complete remission was observed in 25% (2/8) of recipients with recurrence: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Two of 8 patients (25%) remained plas-mapheresis dependant: 0% (0/3) in the less-intensive and 40% (2/5) in the more-intensive group (P = .4643). Response rate (complete/partial) was higher in the more-intensive group (80% [4/5] vs 0% [0/3]; P = .1429); however, overall, the 2 regimens did not show signi-ficantly different outcomes. Comparison between this series and a historical control group of 52 patients with primary focal segmental glomerulos-clerosis trans-planted at our center and not receiving plasmapheresis prophylaxis did not demonstrate any advantages. Conclusions: No benefits from prophylactic plasma-pheresis in deceased-donor kidney transplant recipients with primary focal segmental glomerulo-sclerosis were shown. Prospective randomized studies comparing alternative preemptive strategies are warranted.
机译：目的：据报道患有原发灶性节段性肾小球硬化的肾移植受者的复发率高，移植物存活率低。血浆置换术被广泛用于治疗移植后复发性局灶性节段性肾小球硬化症，但预防性血浆置换术的有效性仍存在争议。材料和方法：在此单中心回顾性研究中，分析了21位接受预防性血浆置换的成年死者供肾肾脏移植受者。其中，仅10例接受了移植后预防性血浆置换（强度较低的治疗方案），而11例接受了移植前和移植后预防性血浆置换（较高强度的治疗方案）。复发患者接受类固醇和血浆置换术治疗。中位随访时间为45个月（四分位间距为30-107个月）。结果：最后一次访视时，有20/21例患者（95％）活着，有17/21例（81％）的患者具有功能正常的移植物。累计局灶节段性肾小球硬化复发率是38％（8/21）：低强度组为30％（3/10），高强度组为45％（5/11）（P = .6594）。 8例复发患者中有4例（50％）因复发而最终导致移植物丢失：低强度组100％（3/3），高强度组20％（1/5）（P = .1429） 。在25％（2/8）的复发患者中观察到完全缓解：低强度组为0％（0/3），高强度组为40％（2/5）（P = .4643）。 8例患者中有2例（25％）仍然依赖血浆置换：低强度组为0％（0/3），高强度组为40％（2/5）（P = .4643）。高强度组的反应率（完全/部分）较高（80％[4/5]对0％[0/3]; P = .1429）;然而，总的来说，这两种方案并未显示出显着不同的结果。该系列与52例原发于我们中心的原发性局灶性节段性肾小球硬化患者的历史对照组之间的比较没有显示出任何预防血浆置换的优势。结论：对于原发性局灶性节段性肾小球硬化症的死者肾移植受者，预防性血浆置换无益处。必须进行前瞻性随机研究，以比较其他先发策略。

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