肾移植相关血栓性微血管病的诊断及治疗进展

李大伟; 张明

doi:10.3969/j.issn.1674-7445.2023.01.009

肾移植相关血栓性微血管病的诊断及治疗进展

doi: 10.3969/j.issn.1674-7445.2023.01.009

李大伟,
张明^,

200120 上海，上海交通大学医学院附属仁济医院泌尿外科

基金项目:

国家自然科学基金 81800657

中国器官移植发展基金会器官移植专项扶持“菁英计划” 2019JYJH14

详细信息

作者简介:

通讯作者:
张明, Email: drmingzhang@126.com

中图分类号: R617, R543
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- 被引次数: 0
出版历程
- 收稿日期: 2022-09-28
- 网络出版日期: 2023-01-17
- 刊出日期: 2023-01-15

Progress on diagnosis and treatment of kidney transplantation-associated thrombotic microangiopathy

Li Dawei,
Zhang Ming^,

Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200120, China

More Information

Corresponding author: Zhang Ming, Email: drmingzhang@126.com

摘要

摘要: 血栓性微血管病（TMA）是肾移植术后较为严重的并发症，以血小板减少、微血管溶血性贫血和急性肾损伤为主要特征，可导致移植肾失功甚至受者死亡。随着我国实体器官移植数量的不断增加，以及对TMA认识的提高，其相关研究也在逐步深入。肾移植相关TMA病因多样，临床表现各异，缺乏特异性的无创检测手段。多数TMA的确诊依赖于肾穿刺活组织检查，但由于TMA多伴随有血小板明显降低，肾穿刺风险较大，明确诊断存在一定困难。针对肾移植相关TMA，目前通常使用血浆置换、静脉注射免疫球蛋白以及停用潜在风险药物等综合治疗方式，但总体预后不佳。本文现就肾移植术后TMA的分类、肾移植相关TMA的诊断及治疗做一综述，以期为临床肾移植相关TMA的诊断和治疗提供参考。
- 肾移植 /
- 血栓性微血管病 /
- 非典型溶血尿毒综合征 /
- 血栓性血小板减少性紫癜 /
- 免疫抑制药 /
- 感染 /
- 抗体介导的排斥反应 /
- 依库珠单抗
Abstract: Thrombotic microangiopathy (TMA) is a severe complication after kidney transplantation, mainly characterized by thrombocytopenia, microvascular hemolytic anemia and acute kidney injury, which may lead to kidney allograft failure or even death of the recipients. With the increasing quantity of solid organ transplantation in China and deeper understanding of TMA, relevant in-depth studies have been gradually carried out. Kidney transplantation-associated TMA is characterized with different causes and clinical manifestations. Non-invasive specific detection approach is still lacking. The diagnosis of TMA mainly depends on renal biopsy. However, most TMA patients are complicated with significant thrombocytopenia. Hence, renal puncture is a risky procedure. It is difficult to make a definite diagnosis. For kidney transplantation-associated TMA, plasma exchange, intravenous immunoglobulin and withdrawal of potential risk drugs are commonly employed. Nevertheless, the overall prognosis is poor. In this article, the classification of TMA after kidney transplantation, diagnosis and treatment of kidney transplantation-associated TMA were reviewed, aiming to provide reference for clinical diagnosis and treatment of kidney transplantation-associated TMA.
- Kidney transplantation /
- Thrombotic microangiopathy /
- Atypical hemolytic uremic syndrome /
- Thrombotic thrombocytopenic purpura /
- Immunosuppressant /
- Infection /
- Antibody-mediated rejection /
- Ecurizumab

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