高敏肾移植受者的脱敏治疗策略

Advances of desensitization protocols in pre-sensitized renal allograft recipients

高敏受者肾移植术后发生超急性和急性排斥反应风险明显增加。针对供者的特异性抗体及记忆性T细胞在高敏受者肾移植排斥反应中起关键作用,是制约移植成功和移植物的长期存活的主要障碍。寻找有效的脱敏方法是当前移植临床的重大挑战之一。本文总结分析接受脱敏疗法受者的临床资料,探讨当前临床脱敏方法的效果,包括急、慢性抗体介导排斥反应的发生率,新型脱敏制剂的使用及高敏受者治疗策略的方向。

Pre-sensitized patients have a higher risk of rejecting renal allografts. Donor-specific anti-HLA antibodies （DSAs） and memory T cells play a critical role in renal transplant rejection and represent a major obstacle for a successful long-term outcome in kidney transplantation. The development of effective desensitization protocols is a pressing therapeutic challenge for transplant clinic. Since the late 1990s, there has been a quest for therapeutic strategies to allow for successful transplantation in highly sensitized patients. This review discusses desensitization protocols in pre-sensitized renal allograft recipients and their outcomes including acute and chronic antibody-mediated rejection rate, the new agents available, and the future directions in sensitized patients.