C4d和供者特异性抗体检测在肾移植抗体介导排斥反应中的应用研究进展

C4d and donor specific antibody in the application research of antibody-mediated rejection

抗体介导排斥反应(AMR)已经成为导致移植物丢失的主要原因。C4d在管周毛细血管(PTC)部位沉积是肾移植体液免疫活跃的标志,单纯C4d阳性不能确诊为AMR,当临床上出现循环供者特异性抗体(DSA)、病理特征和/或移植肾功能不全时必须考虑AMR。C4d和DSA检测阳性与移植物存活率下降密切相关,特别是在检测时就出现移植物功能不全者。本文主要围绕C4d和DSA检测在肾移植AMR中的应用研究作一综述。

Antibody-mediated rejection （AMR） has become a main reason in graft loss. The detection of CAd deposition in peritubular capillarie （PTC） is a valuable marker of humoral activity in the renal allograft. C4d positivity alone is nondiagnostic for antibody-mediated rejection. Presence of circulating HLA donor-specific antibody （DSA）, histologic features, and/or graft dysfunction must be considered in the context of the clinical scenario. C4d positivity and DSA, particularly complement fixing, are associated with decreased allograft survival, particularly when detected in the setting of graft dysfunction.