Akalin Enver
Renal Division and Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, N.Y., USA.
Contrib Nephrol. 2009;162:27-34. doi: 10.1159/000170810. Epub 2008 Oct 31.
Recent desensitization protocols using the combination of plasmapheresis (PP) or immunoadsorption to remove donor-specific anti-HLA antibodies (DSA) and/or intravenous immunoglobulin (IVIG) and rituximab to downregulate antibody-mediated immune responses have made kidney transplantation feasible by abrogating cross-match positivity. Despite good short-term patient and graft survival, acute antibody-mediated rejection (AMR) continued to be an important barrier seen in 20-30% of patients receiving desensitization protocols and it is still not clear which protocol (high-dose IVIG, PP/low-dose IVIG), what type of induction treatment (thymoglobulin, anti-IL-2R antibodies, alemtuzumab), or addition of rituximab is better for the prevention of early acute AMR. Future prospective, multicenter, and randomized trials are required to decide the ideal protocol for sensitized patients.
近期的脱敏方案采用血浆置换（PP）或免疫吸附联合应用以清除供体特异性抗人白细胞抗原抗体（DSA）和/或静脉注射免疫球蛋白（IVIG），并使用利妥昔单抗下调抗体介导的免疫反应，通过消除交叉配型阳性使肾移植成为可能。尽管患者和移植物短期存活良好，但急性抗体介导的排斥反应（AMR）仍是20%-30%接受脱敏方案患者中一个重要的障碍，目前仍不清楚哪种方案（高剂量IVIG、PP/低剂量IVIG）、何种诱导治疗类型（抗胸腺细胞球蛋白、抗白细胞介素-2受体抗体、阿仑单抗）或添加利妥昔单抗对预防早期急性AMR更好。未来需要进行前瞻性、多中心和随机试验来确定适合致敏患者的理想方案。
