Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Curr Opin Organ Transplant. 2008 Aug;13(4):405-10. doi: 10.1097/MOT.0b013e3283071450.
Neither the concept nor the formal application of unacceptable antigens is new. However, identification of unacceptable antigens is now sufficiently accurate to be used as a virtual crossmatch, which can both prevent the unnecessary shipment of organs and increase the access for sensitized patients.
Desensitization protocols and an increasing array of cell-depleting agents can overcome the immunological barriers to transplantation for some patients, reducing the risk of graft rejection to an acceptable level. Increasingly sensitive and specific assays for identifying HLA antigens and antibodies are providing more accurate definition of incompatibilities. Additionally, tests of various biomarkers may permit characterization of responder types.
The definition of unacceptable antigens is determined by the clinical protocols and the physiological and immunological characteristics of the recipient and donor. These data should be integrated to maximize the opportunity for transplantation. The development of additional tests to assess a patient's capacity for recognizing and responding to a transplant will improve the identification of incompatible donor-recipient pairs.
不可接受抗原的概念和正式应用都不是新的。然而，不可接受抗原的识别现在已经足够准确，可以用作虚拟交叉配型，这既可以防止不必要的器官运输，又可以增加致敏患者的机会。
脱敏方案和越来越多的细胞耗竭剂可以克服一些患者移植的免疫障碍，将移植物排斥的风险降低到可接受的水平。用于识别 HLA 抗原和抗体的越来越敏感和特异的检测方法提供了对不相容性的更准确定义。此外，各种生物标志物的检测可能允许对反应者类型进行特征描述。
不可接受抗原的定义取决于临床方案以及受者和供者的生理和免疫学特征。应整合这些数据以最大限度地提高移植机会。开发额外的测试来评估患者识别和对移植做出反应的能力将提高对不相容供体-受者对的识别。
