小肠移植免疫抑制方案的发展历史、现状和展望

History,current status,and perspective of immunosuppressive protocols in small bowel transplantation

经过近20多年的发展,小肠移植已成为肠衰竭患者最为理想的临床治疗方式。然而,小肠作为一个特殊的免疫器官,移植肠排斥反应成为影响小肠移植成功的最主要障碍,因此免疫抑制方案的改进在所有小肠移植技术进步中最为关键。本文首先阐述小肠的免疫学特点,然后结合美国器官获取和移植网络/器官移植受者科学登记系统最新资料、全球各主要小肠移植中心的免疫抑制方案演变和我国临床小肠移植实践经验,评述小肠移植免疫抑制方案发展历程,以期预示其今后的发展。

Small bowel transplantation （SBT） has become a life- saving therapy in patients with irreversible loss of intestinal function in the past 2 decades. However, small intestine is a unique immune organ; rejection of intestinal graft has become the most major obstacle of successful SBT. Therefore, progress of immunosuppressive protocols is the key issue in the evolution of SBT. After discussing the immunological characteristics of small intestine, we reviewed the evolutionary course, current status, and perspective of immunosuppressive protocols in SBT with the data of Organ Procurement and Transplantation Network/the Scientific Registry of Transplant Recipients, evolution of protocols in the major SBT centers worldwide, and the preliminary experience in China