Renal transplantation in anti-neutrophil cytoplasmic antibody-associated vasculitis

被引:22
作者
Hruskova, Zdenka [1 ,2 ]
Geetha, Duvuru [3 ]
Tesar, Vladimir [1 ,2 ]
机构
[1] Charles Univ Prague, Fac Med 1, Dept Nephrol, Prague, Czech Republic
[2] Gen Univ Hosp Prague, Prague, Czech Republic
[3] Johns Hopkins Univ, Dept Med, Div Nephrol, Baltimore, MD USA
关键词
ANCA; outcome; relapse; renal transplantation; vasculitis; ANCA-ASSOCIATED VASCULITIS; SMALL-VESSEL VASCULITIS; MICROSCOPIC POLYANGIITIS; WEGENERS-GRANULOMATOSIS; REPLACEMENT THERAPY; RITUXIMAB; SURVIVAL; DISEASE; DIALYSIS; PROTEINASE-3;
D O I
10.1093/ndt/gfu328
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Despite major advances in the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) achieved in the last decades, a large proportion of AAV patients still develop end-stage renal disease. The survival of AAV patients dependent on dialysis is significantly worse compared with dialysis-independent AAV patients, but is comparable to other non-diabetic patients requiring dialysis. Renal transplantation (RTx) is the method of choice among renal replacement therapies and there has been increasing evidence that it is a suitable method with favorable patient- and graft-survival also in AAV patients. It is recommended to perform RTx after a parts per thousand yen12 months of remission, and ANCA positivity at the time of RTx is generally not considered a contraindication. Even though the risk of relapse after RTx is relatively low with current post-transplant immunosuppressive regimens, disease recurrence may occur. Besides cyclophosphamide, rituximab might become a therapeutic alternative for post-transplant AAV recurrence in the near future but its efficacy and safety in this setting needs to be confirmed in larger studies.
引用
收藏
页码:i159 / i163
页数:5
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