Glotz Denis, Antoine Corinne, Julia Pierre, Pegaz-Fiornet Béatrice, Duboust Alain, Boudjeltia Samir, Fraoui Rabah, Combes Myriam, Bariety Jean
Department of Nephrology, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.
Transpl Int. 2004 Jan;17(1):1-8. doi: 10.1007/s00147-003-0674-3. Epub 2003 Dec 19.
Transplantation for patients possessing allo-antibodies against HLA antigens can be delayed for years, and, once the graft has been transplanted, its survival is significantly reduced. We and others have shown that administration of intravenous immunoglobulins (IVIgs) can induce a profound and sustained decrease in the titres of the anti-HLA antibodies, thus greatly enhancing the chances of those patients to obtain a transplant. In a number of cases, pre-treatment sera contained anti-donor antibodies that disappeared after IVIg administration. A similar approach, combining plasmapheresis and low-dose IVIgs, has shown similar results and has been successfully applied to ABO-incompatible transplantations. Patient and graft survival are excellent, despite a rather high rate of rejections, most notably humoral ones. These protocols thus demonstrate that the presence of anti-donor antibody, once an absolute contra-indication to transplantation, can, nowadays, be considered as an immunological hurdle that can be managed through appropriate immunological manipulation.
对于拥有针对HLA抗原的同种抗体的患者，移植可能会推迟数年，而且一旦进行移植，移植物的存活率会显著降低。我们和其他人已经表明，静脉注射免疫球蛋白（IVIg）可以使抗HLA抗体的滴度大幅且持续下降，从而大大增加这些患者获得移植的机会。在许多病例中，治疗前血清中含有的抗供体抗体在注射IVIg后消失。一种类似的方法，即联合血浆置换和低剂量IVIg，也显示出类似的结果，并已成功应用于ABO血型不相容的移植。尽管排斥反应发生率相当高，尤其是体液排斥反应，但患者和移植物的存活率都很高。因此，这些方案表明，曾经作为移植绝对禁忌症的抗供体抗体的存在，如今可以被视为一种可以通过适当的免疫操作来应对的免疫障碍。
