Antibody-mediated rejection(ABMR) has increasingly emerged as an important cause of allograft loss after intestinal transplantation(ITx). Compelling evidence indicates that donor-specific antibodies can mediate and pr...Antibody-mediated rejection(ABMR) has increasingly emerged as an important cause of allograft loss after intestinal transplantation(ITx). Compelling evidence indicates that donor-specific antibodies can mediate and promote acute and chronic rejection after ITx. However, diagnostic criteria for ABMR after ITx have not been established yet and the mechanisms of antibodymediated graft injury are not well-known. Effective approaches to prevent and treat ABMR are required to improve long-term outcomes of intestine recipients. Clearly, ABMR after ITx has become an important area for research and clinical investigation.展开更多
Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the reco...Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the records of 1 277 patients who underwent cadaveric renal transplantation with good human leukocyte antigen (HLA) matching with the donors from 1978 to 1998. Four hundred and twenty-three patients underwent renal transplantation from 1978 to 1990 without PRA examination made up the first group. The other 854 patients with PRA level examination before the operation from 1991 to 1998 were regarded as the second group. Preoperative plasmaphereses were performed for those with PM levels higher than 30%. The episodes of hyperacute rejection, acute rejection and l-, 3- and 5-year patient/graft survival rate were evaluated. To rule out the interference of different immunosuppressants, we made a comparative study between the recipients with uncorrectable high PRA levels (> 20% ) in the second group and those with reduced PRA levels (< 10% ) by plasmaphere- sis. Results: In the first group, 9 (2.l%) hyperacute rejection and 198 (47%) acute rejection occurred The 1-, 3- and 5-year patient/graft survival rates were 86. 7%/76. 3%, 72. 5%/67. 9% and 87 .0%/81. 6%, respectively. In the second group, no hyperacute rejection happened and acute rejection was occurred in 162 cases (19.0% ), and the l-, 3- and 5year patient/graft survival rates were 97. 3%/95.0%, 92%/84. 2% and 87.0%/81 .6%, much lower than that in the first group. Of the 49 recipients with high PRA levels, 33 had PRA levels below 10% after plasmapheresis, who had a lower incidence of ocute rejection, a higher rate of rejection reversal and a higher graft survival rate at 1, 3 and 5 years than the rest 16 cases (PRA > 20% after plasmapheresis). Conclusion: The PRA level examination and PRA clearance are important for the success of renal transplantation. They help eradicate the hyperacute rejection, reduce the risk of acute rejection and improve patient and graft survival.展开更多
Calcineurin inhibitors(CNIs) represent today a cornerstone for the maintenance immunosuppressive treatment in solid organ transplantation. Nevertheless, several attempts have been made either to minimize their dosage ...Calcineurin inhibitors(CNIs) represent today a cornerstone for the maintenance immunosuppressive treatment in solid organ transplantation. Nevertheless, several attempts have been made either to minimize their dosage or to avoid CNIs at all because these drugs have the severe side effect of chronic nephrotoxicity. This issue represents a frontier for renal transplantation. The principal problem is to understanding whether the poor outcome over the long-term may be ascribed to CNIs nephrotoxicity or to the inability of these drugs to control the acute and chronic rejection B cells mediated. The authors analyze extensively all the international trials attempting to withdraw, minimize or avoid the use of CNIs. Few trials undertaken in low risk patients with an early conversion from CNIs to proliferation signal inhibitors were successful, but the vast majority of trials failed to improve CNIs side effects. To date the use of a new drug, a co-stimulation blocker, seems promising in avoiding CNIs with similar efficacy, better glomerular filtration rate and an improved metabolic profile. Moreover the use of this drug is not associated with the development of donorspecific anti-human leukocyte antigen antibodies. Thispoint has a particular relevance, because the failure of CNIs to realize good outcomes in renal transplantation has recently ascribed to their inability to control the acute and chronic rejections B-cell mediated. This paper analyzes all the recent studies that have been done on this issue that represents the real frontier that should be overcome to realize better results over the long-term after transplantation.展开更多
目的 肾脏移植的致敏性是目前临床面临的一大难题，高致敏受者接受移植的机会大大减少，我们对1例高致敏受者肾移植围手术期采用蛋白A免疫吸附疗法配合免疫抑制治疗，观察其临床效果，结合文献评估疗效。方法受者采用蛋白A免疫吸附成功...目的 肾脏移植的致敏性是目前临床面临的一大难题，高致敏受者接受移植的机会大大减少，我们对1例高致敏受者肾移植围手术期采用蛋白A免疫吸附疗法配合免疫抑制治疗，观察其临床效果，结合文献评估疗效。方法受者采用蛋白A免疫吸附成功进行肾移植病例，同时回顾通过国内外文献检索得到的蛋白A免疫吸附治疗肾移植高致敏受者的病例。结果结合我们目前的病例，分析已被报道的66例（国内30例，国外36例）蛋白A免疫吸附治疗肾移植高致敏受者的病例，发现大部分患者采用了蛋白A免疫吸附可以明显降低IgG、IgM、IgA等，PRA从术前30％～100％降低到术后30％以下，65例成功进行了肾移植。结论 Protein A免疫吸附可以清除体内免疫球蛋白疗效明显，结合免疫抑制治疗使肾移植高致敏受者成功接受肾移植，提高移植肾远期存活率。展开更多
基金Supported by The grant from the National Natural Science Foundation of China,No.81570588
文摘Antibody-mediated rejection(ABMR) has increasingly emerged as an important cause of allograft loss after intestinal transplantation(ITx). Compelling evidence indicates that donor-specific antibodies can mediate and promote acute and chronic rejection after ITx. However, diagnostic criteria for ABMR after ITx have not been established yet and the mechanisms of antibodymediated graft injury are not well-known. Effective approaches to prevent and treat ABMR are required to improve long-term outcomes of intestine recipients. Clearly, ABMR after ITx has become an important area for research and clinical investigation.
文摘Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the records of 1 277 patients who underwent cadaveric renal transplantation with good human leukocyte antigen (HLA) matching with the donors from 1978 to 1998. Four hundred and twenty-three patients underwent renal transplantation from 1978 to 1990 without PRA examination made up the first group. The other 854 patients with PRA level examination before the operation from 1991 to 1998 were regarded as the second group. Preoperative plasmaphereses were performed for those with PM levels higher than 30%. The episodes of hyperacute rejection, acute rejection and l-, 3- and 5-year patient/graft survival rate were evaluated. To rule out the interference of different immunosuppressants, we made a comparative study between the recipients with uncorrectable high PRA levels (> 20% ) in the second group and those with reduced PRA levels (< 10% ) by plasmaphere- sis. Results: In the first group, 9 (2.l%) hyperacute rejection and 198 (47%) acute rejection occurred The 1-, 3- and 5-year patient/graft survival rates were 86. 7%/76. 3%, 72. 5%/67. 9% and 87 .0%/81. 6%, respectively. In the second group, no hyperacute rejection happened and acute rejection was occurred in 162 cases (19.0% ), and the l-, 3- and 5year patient/graft survival rates were 97. 3%/95.0%, 92%/84. 2% and 87.0%/81 .6%, much lower than that in the first group. Of the 49 recipients with high PRA levels, 33 had PRA levels below 10% after plasmapheresis, who had a lower incidence of ocute rejection, a higher rate of rejection reversal and a higher graft survival rate at 1, 3 and 5 years than the rest 16 cases (PRA > 20% after plasmapheresis). Conclusion: The PRA level examination and PRA clearance are important for the success of renal transplantation. They help eradicate the hyperacute rejection, reduce the risk of acute rejection and improve patient and graft survival.
文摘Calcineurin inhibitors(CNIs) represent today a cornerstone for the maintenance immunosuppressive treatment in solid organ transplantation. Nevertheless, several attempts have been made either to minimize their dosage or to avoid CNIs at all because these drugs have the severe side effect of chronic nephrotoxicity. This issue represents a frontier for renal transplantation. The principal problem is to understanding whether the poor outcome over the long-term may be ascribed to CNIs nephrotoxicity or to the inability of these drugs to control the acute and chronic rejection B cells mediated. The authors analyze extensively all the international trials attempting to withdraw, minimize or avoid the use of CNIs. Few trials undertaken in low risk patients with an early conversion from CNIs to proliferation signal inhibitors were successful, but the vast majority of trials failed to improve CNIs side effects. To date the use of a new drug, a co-stimulation blocker, seems promising in avoiding CNIs with similar efficacy, better glomerular filtration rate and an improved metabolic profile. Moreover the use of this drug is not associated with the development of donorspecific anti-human leukocyte antigen antibodies. Thispoint has a particular relevance, because the failure of CNIs to realize good outcomes in renal transplantation has recently ascribed to their inability to control the acute and chronic rejections B-cell mediated. This paper analyzes all the recent studies that have been done on this issue that represents the real frontier that should be overcome to realize better results over the long-term after transplantation.
文摘目的 肾脏移植的致敏性是目前临床面临的一大难题，高致敏受者接受移植的机会大大减少，我们对1例高致敏受者肾移植围手术期采用蛋白A免疫吸附疗法配合免疫抑制治疗，观察其临床效果，结合文献评估疗效。方法受者采用蛋白A免疫吸附成功进行肾移植病例，同时回顾通过国内外文献检索得到的蛋白A免疫吸附治疗肾移植高致敏受者的病例。结果结合我们目前的病例，分析已被报道的66例（国内30例，国外36例）蛋白A免疫吸附治疗肾移植高致敏受者的病例，发现大部分患者采用了蛋白A免疫吸附可以明显降低IgG、IgM、IgA等，PRA从术前30％～100％降低到术后30％以下，65例成功进行了肾移植。结论 Protein A免疫吸附可以清除体内免疫球蛋白疗效明显，结合免疫抑制治疗使肾移植高致敏受者成功接受肾移植，提高移植肾远期存活率。
