Uber W E, Self S E, Van Bakel A B, Pereira N L
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Am J Transplant. 2007 Sep;7(9):2064-74. doi: 10.1111/j.1600-6143.2007.01900.x. Epub 2007 Jul 5.
Acute antibody-mediated rejection (AMR) in heart transplantation is often associated with hemodynamic compromise, and is associated with increased mortality and development of accelerated transplant coronary artery disease (TCAD). The diagnosis of AMR has historically been controversial and outcomes with aggressive immunosuppressive therapy including plasmapheresis and cyclophosphamide are poor. Advances in diagnostic techniques like the demonstration of immunopathologic evidence for antibody-mediated rejection by deposition of the complement split product C4d in tissue and detection of anti-HLA antibodies by flow cytometry will assist in further characterizing AMR. Immunosuppression targeting B-lymphocytes and use of m-TOR inhibitors to alter the predilection to develop TCAD and improve survival in AMR remains to be proven.
心脏移植中的急性抗体介导排斥反应（AMR）常伴有血流动力学障碍，且与死亡率增加及加速性移植冠状动脉疾病（TCAD）的发生相关。AMR的诊断一直存在争议，包括血浆置换和环磷酰胺在内的积极免疫抑制治疗效果不佳。诊断技术的进步，如通过组织中补体裂解产物C4d沉积来证明抗体介导排斥反应的免疫病理学证据，以及通过流式细胞术检测抗HLA抗体，将有助于进一步明确AMR。针对B淋巴细胞的免疫抑制以及使用m-TOR抑制剂来改变发生TCAD的倾向并提高AMR患者的生存率，仍有待证实。
