Triulzi D J, Nalesnik M A
Department of Pathology, University of Pittsburgh Medical Center and the Institute for Transfusion Medicine, Pittsburgh, PA 15213, USA.
Transfusion. 2001 Mar;41(3):419-26. doi: 10.1046/j.1537-2995.2001.41030419.x.
The phenomenon of microchimerism and its relationship to long-term graft tolerance is an area of active study. The ability to establish a tolerant state has been enhanced with current immunosuppressive drugs and emerging therapies such as donor HPC infusions. An undesirable outcome of host-donor WBC interaction is GVHD. GVHD is a rare complication reported most frequently in liver transplantation. Two cases of GVHD reported in recipients of organs from donors homozygous for a shared HLA haplotype would support a policy of avoiding the use of these donors. TA-GVHD is very rare in solid organ transplant recipients, with only four published cases; only two had convincing supportive evidence and one of these had an underlying hematologic abnormality. These few cases do not support a policy of routine irradiation of cellular blood components for all solid organ transplant recipients. The use of donor HPC infusions to enhance chimerism and graft tolerance has increased the number of GVHD cases observed (usually mild) and decreased the severity and number of rejection episodes. The long-term effects of donor HPC infusions on graft survival is under investigation.
微嵌合体现象及其与长期移植物耐受的关系是一个正在积极研究的领域。目前的免疫抑制药物以及诸如供体造血干细胞输注等新兴疗法提高了建立耐受状态的能力。宿主 - 供体白细胞相互作用的一个不良后果是移植物抗宿主病（GVHD）。GVHD是一种罕见的并发症，在肝移植中报道最为频繁。在接受来自共享HLA单倍型纯合供体器官的受者中报告的两例GVHD病例支持避免使用这些供体的政策。TA - GVHD在实体器官移植受者中非常罕见，仅有四例发表的病例；只有两例有令人信服的支持证据，其中一例有潜在的血液学异常。这少数病例不支持对所有实体器官移植受者常规照射细胞血液成分的政策。使用供体造血干细胞输注来增强嵌合体和移植物耐受增加了观察到的GVHD病例数量（通常为轻度），并降低了排斥反应的严重程度和数量。供体造血干细胞输注对移植物存活的长期影响正在研究中。
