移植肾抗体介导的排斥反应的诊治新进展

Antibody-mediated rejection in kidney transplantation: diagnosis and management

肾移植是终末期肾病有效的治疗手段之一,但抗体介导的排斥反应(ABMR)是影响移植肾预后的最严重最危险的因素。以往ABMR是以C4d在移植肾肾小管周围毛细血管(PTC)沉积作为诊断标准,最近提出了C4d阴性的ABMR,使得ABMR检出率大大提高。影响ABMR预后的危险因素包括C4d在移植肾PTC沉积、供者特异性抗体(DSA)、与补体结合的DSA及亚临床ABMR。ABMR的治疗策略主要是清除预存抗体和抑制新抗体的产生,抑制新抗体产生的治疗包括使用抗CD20单克隆抗体、硼替佐米、抗C5a单克隆抗体等方法。

Kidney transplant is the preferred treatment of end-stage renal disease. One of the most challenging aspects of kidney transplant is the prevention and treatment of antibody-mediated rejection（ ABMR）,which is one of the main causes of graft dysfunction and early graft loss. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Despite its prevalence and clinical significance,few well-studied treatment options have been proposed.Currently, plasmapheresis with or without immunoabsorption, high-dose intravenous immunoglobulin, rituximab,bortezomib and eculizumab have been proposed in the treatment of ABMR individually or in various combinations. Robust clinical trials are urgently needed to address this major cause of allograft loss. This review will summarize the current knowledge of the pathophysiology,diagnosis,and management of ABMR.