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Disease Recurrence-The Sword of Damocles in Kidney Transplantation for Primary Focal Segmental Glomerulosclerosis.
Kienzl-Wagner, Katrin; Waldegger, Siegfried; Schneeberger, Stefan.
Afiliación
  • Kienzl-Wagner K; Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
  • Waldegger S; Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
  • Schneeberger S; Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Front Immunol ; 10: 1669, 2019.
Article en En | MEDLINE | ID: mdl-31379860
ABSTRACT
A major obstacle in kidney transplantation for primary focal segmental glomerulosclerosis (FSGS) is the risk of disease recurrence. Recurrent FSGS affects up to 60% of first kidney grafts and exceeds 80% in patients who have lost their first graft due to recurrent FSGS. Clinical and experimental evidence support the hypothesis that a circulating permeability factor is the mediator in the pathogenesis of primary and recurrent disease. Despite all efforts, the causing agent has not yet been identified. Several treatment options for the management of recurrent FSGS have been proposed. In addition to plasma exchange, B-cell depleting antibodies are effective in recurrent FSGS. This indicates, that the secretion and/or activity of the postulated circulating permeability factor(s) may be B-cell related. This review summarizes the current knowledge on permeability factor(s) possibly related to the disease and discusses strategies for the management of recurrent FSGS. These include profound B-cell depletion prior to transplantation, as well as the salvage of an allograft affected by recurrent FSGS by transfer into a second recipient.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Glomeruloesclerosis Focal y Segmentaria Tipo de estudio: Prognostic_studies Límite: Animals / Humans Idioma: En Revista: Front Immunol Año: 2019 Tipo del documento: Article País de afiliación: Austria

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Glomeruloesclerosis Focal y Segmentaria Tipo de estudio: Prognostic_studies Límite: Animals / Humans Idioma: En Revista: Front Immunol Año: 2019 Tipo del documento: Article País de afiliación: Austria