肾移植受者排斥反应的风险评估  

Pretransplant immunological risk assessment

作　　者：李雪[1] 唐政[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所,博士研究生南京210016

出　　处：《肾脏病与透析肾移植杂志》2016年第6期568-572,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2015BAI12B05);第一批国家临床重点专科项目(2014ZDZK001)

摘　　要：对肾移植受者进行排斥反应风险免疫学评估是个体化使用免疫抑制剂的重要依据。目前认为,年龄越大的供肾免疫原性越强,而脑死亡后器官捐献(DBD)是血管性排斥反应的危险因素。年轻、非裔美国人、依从性差和多次妊娠会增加肾移植受者术后排斥反应的风险。实验室检查方面,补体依赖微量淋巴细胞毒(CDC)试验、供者特异性抗体(DSA)检测和人类白细胞抗原(HLA)配型是肾移植受者免疫学风险的重要评价方法。另外,移植肾功能延迟恢复(DGF)和冷缺血时间长也是移植术后排斥反应的危险因素。Pretransplant risk assessment is an important basis for individual use of immunosuppressive agents.The accuracy of immunological risk assessment include many factors.For donors,deceased donation and older donor age remains a significant predictor.For recipient-related risk factors for acute rejection,the most compelling evidence points to younger age,African American ethnicity,non-adherence to medication,and female patients with more than one pregnancy.At the time of transplant,delayed graft function is one of the most clear-cut risk factors for acute rejection.Extended cold ischemia time（ ≥24h） may also play a contributory role. Conventional immunological markers,eg human leukocyte antigen（ HLA）,mismatching,complement-dependent cytotoxic（ CDC） testing and pretransplant anti-HLA alloantibodies） are being reassessed. Together,these offer a realistic basis for planning an appropriate immunosuppression regimen in individual patients.

关 键 词：肾移植 免疫风险 排斥反应 个体化治疗 

分 类 号：R699.2[医药卫生—泌尿科学]