抗中性粒细胞胞质抗体相关肾炎患者肾移植的转归

Outcome of patients with ANCA-associated glomerulonephritis after renal transplantation

目的:回顾性分析抗中性粒细胞胞质抗体(ANCA)相关肾炎(AAGN)患者接受肾移植后的转归。方法:11例AAGN患者[男4例,女7例,中位年龄48(33.5~52.5)岁]接受肾移植。采用激素、吗替麦考酚酯联合他克莫司/环孢素A三联抗排斥治疗。肾移植后排斥反应及其类型均经移植肾活检病理诊断。回顾性分析移植肾预后、血管炎复发及血清ANCA对移植肾预后的影响。结果:11例AAGN均为MPO-ANCA相关血管炎,10例在肾移植前接受肾脏替代治疗,中位时间为30.5(14.8~50.5)个月。肾移植前均无血管炎活动(BVAS 0分),7例血清MPO-ANCA阳性。肾移植术后均未出现移植肾功能延迟恢复,4例(36.4%)发生急性细胞性排斥反应,分别有1例术后18个月和22个月发生血管炎复发和慢性体液性排斥反应。术后中位随访56(46.5~135)个月,随访末8例(72.7%)血清肌酐水平正常,2例血清肌酐升高,1例移植肾失功。5年人、肾生存率分别为100%和90.9%。术前ANCA阳性与阴性患者比较移植肾排斥反应发生率和血管炎复发率均无显著差异。结论:AAGN患者肾脏移植后远期预后好,血管炎复发率低,但术后早期急性排斥反应发生率高,应加强预防抗排斥反应。

Objective： To retrospectively analyze the outcome of kidney allograft for ESRD resulted from ANCAassociated glomerulonephritis（ AAGN）. Methodology： Eleven patients with AAGN who received renal transplantation（ RTx） between 1994 and 2013 were enrolled in this study. Overall allograft outcome,AAV recurrence and the association of the serum ANCA titer with allograft outcome were investigated. Results： All ESRD cases were resulted from microscopic polyangiitis（ MPA）. Ten patients received renal replacement therapy（ RRT） before RTx,with median time of30. 5（ 14. 8 - 50. 5） months. There＇s no clinic activity of AAV with BVAS of zero,The median follow-up was 56（ 46. 5 -135） months after RTx. Only one patient（ 9. 09%） experienced AAV recurrence,while four（ 36. 4%） had acute rejection,and one（ 9. 09%） had chronic rejection. At the endpoint of follow-up,eight（ 72. 7%） patients had normal allograft function,while renal insufficiency happened in three patients（ 27. 3%）,in which one had allograft failure. There was no death during follow-up. Five years survival rate in patient and allograft was 100% and 90. 9% respectively. No significant differences were found in allograft failure,AAV recurrence and rejection in patients differed by serum ANCA titer at RTx time. Conclusion： RTx is a safe and effective option for ESRD secondary to AAV. AAV recurrence was rare under current immunosuppression strategy. However,acute rejections may need more attention and prevention.