肾移植受者免疫抑制方案的优化  

Optimization of immunosuppressive regimen for kidney transplant recipients

作　　者：董震[1] 王洪阳 Dong Zhen;Wang Hongyang(Department of Kidney Transplantation,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院肾脏移植科,青岛266000

出　　处：《器官移植》2024年第4期558-562,共5页Organ Transplantation

基　　金：山东省自然科学基金青年项目(ZR2020QH237);青岛大学附属医院青年科学基金(QDFYQN2023120)。

摘　　要：随着手术技术的成熟与发展,以及围手术期管理水平的提高,肾移植手术成功率显著提高。但由于供受者在遗传性与抗原性上存在的明显差异,会导致肾移植术后发生排斥反应,影响移植物的存活。免疫抑制是治疗排斥反应的重要手段,对减少排斥反应发生,提高移植物存活率具有重要意义。但免疫抑制药在减少排斥反应的同时会引起感染、心血管疾病、肿瘤等并发症,严重影响患者的生活质量,甚至可能导致患者死亡。合理地选择免疫抑制药,不断优化受者免疫抑制方案,对改善受者和移植肾的存活具有重要意义。因此,本文就器官移植发展史、免疫诱导治疗、免疫维持治疗进行评述,探讨肾移植受者免疫抑制方案优化取得的进展,以期为改善肾移植预后提供参考。With the maturity and development of surgical techniques,as well as the improvement of perioperative management level,the success rate of kidney transplantation has been significantly improved.However,due to evident differences in heredity and antigenicity between donors and recipients,rejection will occur after kidney transplantation,which will affect the survival of renal grafts.Immunosuppression is an important treatment for rejection,which is of significance to reduce the risk of rejection and enhance graft survival rate.Nevertheless,immunosuppressants may cause multiple complications while lowering the incidence of rejection,such as infection,cardiovascular diseases and tumors,etc.,which seriously affect the quality of life of patients and may even lead to their death.Reasonable selection of immunosuppressants and continuous optimization of immunosuppressive regimen for recipients play a critical role in improving the survival of recipients and renal grafts.In this article,the development history of organ transplantation,immune induction therapy and immune maintenance therapy was reviewed,and the progress in the optimization of immunosuppressive regimens for kidney transplant recipients was discussed,aiming to provide reference for improving clinical prognosis of kidney transplant recipients.

关 键 词：肾移植 免疫抑制药 免疫诱导 免疫维持 感染 糖皮质激素 钙调磷酸酶抑制剂 抗增殖类药物 

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