Jordan Stanley C, Peng Alice, Vo Ashley A
Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, Calif., USA.
Contrib Nephrol. 2009;162:13-26. doi: 10.1159/000170864. Epub 2008 Oct 31.
Intravenous immunoglobulin (IVIG) products are derived from pooled human plasma and have been used for the treatment of primary immunodeficiency disorders for more than 24 years. Shortly after their introduction, IVIG products were found to be effective in the treatment of autoimmune and inflammatory disorders. Rituximab (anti-CD20, anti-B-cell monoclonal antibody) has also shown efficacy in the treatment of autoimmune and inflammatory disorders. We have recently described a beneficial effect of the combination of IVIG + rituximab on the reduction of anti-human leukocyte antigen (HLA) antibodies with subsequent improvement in rates of transplantation for highly HLA-sensitized patients as well as a potent anti-inflammatory effect that is beneficial in the treatment of antibody-mediated rejection. These advancements have enabled patients previously considered poor or unreasonable candidates for transplantation to receive a successful transplant. Alternative approaches to IVIG/rituximab-based desensitization include the addition of plasmapheresis and possible splenectomy. Furthermore, new advancements in detecting donor-specific anti-body and assessment of antibody-mediated injury to allografts (C4d staining) allow for early detection of antibody-mediated rejection and early implementation of IVIG/rituximab therapy to prevent allograft loss.
静脉注射免疫球蛋白（IVIG）产品源自混合人血浆，已用于治疗原发性免疫缺陷疾病超过24年。在其引入后不久，发现IVIG产品在治疗自身免疫性和炎性疾病方面有效。利妥昔单抗（抗CD20，抗B细胞单克隆抗体）在治疗自身免疫性和炎性疾病方面也显示出疗效。我们最近描述了IVIG +利妥昔单抗联合使用对降低抗人白细胞抗原（HLA）抗体的有益作用，随后提高了高度HLA致敏患者的移植成功率，以及对治疗抗体介导的排斥反应有益的强大抗炎作用。这些进展使以前被认为移植不佳或不合理的患者能够成功接受移植。基于IVIG /利妥昔单抗脱敏的替代方法包括增加血浆置换和可能的脾切除术。此外，检测供体特异性抗体和评估抗体介导的同种异体移植物损伤（C4d染色）的新进展有助于早期检测抗体介导的排斥反应，并早期实施IVIG /利妥昔单抗治疗以防止同种异体移植物丢失。
