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肾移植急性排斥反应的临床表现与诊断

Authors
W James Chon, MD, FACP
Daniel C Brennan, MD, FACP
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD
Translators
文进, 副主任医师

引言

肾移植急性排斥反应是造成移植肾功能丧失的主要原因。即使采用最强的抗排异治疗，一些发生急性排斥反应的移植肾也不能恢复功能。 (参见“肾移植急性排斥反应的治疗”)

即使对于那些成功恢复的患者，急性排斥反应对移植肾的远期存活也会产生负面影响。急性排斥反应是间质纤维化/肾小管萎缩(interstitial fibrosis/tubular atrophy, IF/TA)的重要预测因子，IF/TA过去被称作慢性移植肾肾病，是移植一年后多数移植肾失功的原因。 (参见“慢性移植肾肾病”，关于‘急性排斥反应的重要性’一节)

在过去30年间，由于引入了有效的免疫抑制药物，急性排斥反应的发生率已显著下降。然而，制订在预防移植肾排斥反应发生的同时，又可将药物毒性反应、感染、恶性疾病的发生率降至最低的最佳化免疫抑制方案，依然很具挑战性。

关于肾移植急性排斥反应的临床表现和诊断的讨论见本专题。急性排斥反应的治疗参见其他专题。 (参见“肾移植急性排斥反应的治疗”)

定义

肾移植急性排斥反应被定义为，由移植物特异性病理变化引起的移植肾功能急剧恶化。急性排斥反应有两种主要的组织学表现形式：

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-06-30.
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