Crew R John, Ratner Lloyd E
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Semin Dial. 2005 Nov-Dec;18(6):474-81. doi: 10.1111/j.1525-139X.2005.00092.x.
Immunologic incompatibilities between donor and recipient have limited the access to renal transplantation for many patients. Previously the presence of donor-specific alloantibodies directed against donor major histocompatibility complex (MHC) antigens or natural antibodies directed against donor ABO blood group antigens was considered an absolute contraindication to renal transplantation. However, with the current understanding of humoral immune responses, superior immunosuppressive agents, and improved diagnosis and treatment of antibody-mediated rejection, renal transplantation can be safely performed with outstanding results despite the presence of donor-specific antibody. In this review we discuss the biology of antibody-mediated rejection and sensitization. We discuss the diagnostic tests necessary to characterize the type, affinity, and avidity of the donor-directed antibodies. Current methods for performing renal transplants across ABO and human leukocyte antigen (HLA)-sensitized barriers are covered, including the potential morbidities. The rest of the review focuses on advances in managing these antibodies to increase the likelihood of receiving a deceased donor kidney or allow transplantation from a living donor against whom one has a prohibitive antibody.
供体与受体之间的免疫不相容性限制了许多患者接受肾移植的机会。以前，针对供体主要组织相容性复合体（MHC）抗原的供体特异性同种抗体或针对供体ABO血型抗原的天然抗体的存在被视为肾移植的绝对禁忌证。然而，随着目前对体液免疫反应的认识、更优质的免疫抑制剂以及抗体介导排斥反应诊断和治疗的改进，尽管存在供体特异性抗体，肾移植仍可安全进行并取得出色效果。在本综述中，我们讨论了抗体介导的排斥反应和致敏的生物学机制。我们讨论了表征供体定向抗体的类型、亲和力和亲合力所需的诊断测试。涵盖了目前跨越ABO和人类白细胞抗原（HLA）致敏屏障进行肾移植的方法，包括潜在的发病率。综述的其余部分重点关注在管理这些抗体方面取得的进展，以增加接受 deceased 供体肾脏的可能性，或允许从有禁忌抗体的活体供体进行移植。
