异种肾移植的亚临床研究进展

Progress in subclinical research of kidney xenotransplantation

异种移植是目前解决临床器官来源短缺的有效途径之一。随着基因编辑技术及免疫抑制方案不断发展,猪-非人灵长类动物异种肾移植相关研究取得了显著进展,为开启异种肾移植临床应用创造了良好条件。鉴于人与非人灵长类动物实质性差异,同时为了满足现阶段的伦理学要求,猪-人异种肾移植的亚临床研究非常必要。近年来,已有关于基因修饰猪-脑死亡受者异种肾移植的亚临床研究,表明异种肾移植已经进入向临床发展的过渡阶段。然而,供受体选择及免疫抑制应用方案尚未统一,亟需在亚临床研究中进一步明确。本文就异种肾移植亚临床研究中供受体选择、免疫抑制方案、移植术后监测管理等方面的现状和当前面临的主要问题进行综述,以期推动异种肾移植向临床转化。

Xenotransplantation is an efficient pathway to solve the problem of transplant organ source deficiency in clinical settings.With the increasing progress of gene editing technique and immune suppression regimen,important development has been achieved on researches regarding pig to non-human primate kidney xenotransplantation,which provides a good condition for the introduction of the technique in the clinical application.In view of the substantial difference between human and non-human primate,and to meet the needs of current ethic requirements,it is necessary to perform subclinical studies for pig to human kidney xenotransplantation.In recent years,such subclinical studies with regard to the genetically modified pig to brain death recipient kidney xenotransplantation had been performed,indicating that kidney xenotransplantation gradually began to transit to the clinical development stage.However,donor/recipient selection and immune suppression regimen has not reached a consensus yet,and has to be clarified in subclinical studies.In this article,the current status and confronted problems of donor/recipient selection,immune suppression regimen and post transplantation management in the subclinical studies of kidney xenotransplantation were reviewed,aiming to promote the clinical transformation of kidney xenotransplantation to the clinical application.