肾移植排斥反应免疫风险评估与监测  

Assessment and monitoring of immune risk of kidney transplantation rejection

作　　者：郑瑾[1] 薛武军[1] Zheng Jin;Xue Wujun(Department of Kidney Transplantation,Nephropathy Hospital,the First Affiliated Hospital of Xi'an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾病医院肾移植科,710061

出　　处：《器官移植》2021年第6期643-650,共8页Organ Transplantation

基　　金：国家自然科学基金面上项目(81670682)。

摘　　要：肾移植是终末期肾衰竭最有效的治疗方法。虽然目前移植肾早期存活率及功能恢复都得到了很大的提高,但是移植肾长期存活仍有待改善。免疫因素所引发的抗体介导的排斥反应(AMR)及T细胞介导的排斥反应(TCMR)仍是导致移植肾衰竭的最主要因素。本文对肾移植受者等待移植期间、肾移植术前和术后3个阶段的免疫风险评估及监测内容进行了综述,通过对肾移植术前受者体内预存人类白细胞抗原(HLA)抗体和非HLA抗体、HLA匹配、淋巴细胞毒交叉配型、免疫记忆细胞等的评估,对肾移植术后受者进行移植肾程序性活组织检查,HLA抗体和非HLA抗体及供者来源性细胞游离DNA(dd-cfDNA)的监测,制定个体化免疫抑制治疗及监测方案,预防排斥反应发生,及时发现和诊断排斥反应,根据免疫监测结果避免无效治疗或过度治疗,从而优化移植物长期存活。Kidney transplantation is the most efficacious treatment for end-stage renal failure.Although the shortterm survival and functional recovery of the kidney graft have been significantly improved,the long-term survival of the kidney graft remains to be enhanced.Antibody-mediated rejection(AMR)and T cell-mediated rejection(TCMR)caused by immune factors are still the most critical causes of kidney graft failure.In this article,the immune risk assessment and monitoring of kidney transplant recipients during the awaiting period,before and after kidney transplantation were reviewed.Through the evaluation of preexisting human leukocyte antigen(HLA)antibodies and non-HLA antibodies,HLA matching,lymphocytotoxicity cross-matching and immune memory cells in the recipients before kidney transplantation,programmed biopsy of the kidney graft of the recipients after kidney transplantation and monitoring of HLA antibodies,non-HLA antibodies and donor-derived cell-free DNA(dd-cfDNA),individualized immunosuppressive treatment and monitoring regimes could be established,and the incidence of rejection could be prevented,timely detected and diagnosed.According to the immune monitoring results,ineffective treatment or over-treatment could be avoided,thereby improving the long-term survival of kidney graft.

关 键 词：肾移植 排斥反应 免疫风险评估 免疫监测 抗体介导的排斥反应(AMR) T细胞介导的排斥反应(TCMR) 供者来源性细胞游离DNA(dd-cfDNA) 群体反应性抗体 

分 类 号：R617[医药卫生—外科学] R392.4[医药卫生—临床医学]