肾移植术后体液性排斥反应的研究进展  

The research progress of humoral rejection after kidney transplantation

作　　者：于立新[1] 

机构地区：[1]南方医科大学南方医院器官移植科,广州510515

出　　处：《中华移植杂志（电子版）》2015年第3期108-112,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金面上项目(81070594);国家自然科学基金专项基金项目(81350009;81141058);广东省科技计划项目(2012B031800470)

摘　　要：肾移植术后体液性排斥反应,即抗体介导的排斥反应(AMR)是一种预后较差的并发症。AMR由针对供者抗原的特异性抗体介导,造成血管内皮细胞损伤。随着对抗移植物抗体产生以及补体系统激活在排斥反应中作用的深入研究,AMR的治疗也出现新的策略。除了标准的AMR治疗包括血浆置换、静脉输注免疫球蛋白,新型的针对B细胞、浆细胞和补体系统的单克隆抗体,分别如:利妥昔单抗、硼替佐米、依库珠单抗等,被证明能有效治疗肾移植术后AMR。如何采用这些新型免疫抑制剂更好地控制体液免疫并延长移植物的生存,将是未来一段时间的研究热点。Humoral rejection,also known as antibody-mediated rejection（ AMR）,is a complication after kidney transplantation with a poor prognosis. AMR is mediated by antibodies against an allograft and results in histologic changes in allograft vasculature that differs from cellular rejection.With an improved understanding about the importance of the development of antibodies against allografts as well as complement activation,significant advances have occurred in the treatment of AMR. The standard of care for AMR includes plasmapheresis and intravenous immunoglobulin infusion which remove and neutralize antibodies,respectively. Agents targeting B cells（ rituximab）,plasma cells（ bortezomib）,and the complement system（ eculizumab） have also been successfully used to treat AMR in kidney transplant recipients. The key challenges for the next few years will be to learn how to develop a effective strategy with these agents to better control humoral immunity and improve long-term allograft outcome.

关 键 词：肾移植 体液性排斥反应 供者特异性抗体 慢性排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学]