Institute of Medical Immunology, CCM, Germany.
Curr Opin Organ Transplant. 2009 Dec;14(6):650-5. doi: 10.1097/MOT.0b013e32833281f8.
Despite the introduction of advanced immunosuppressive drug therapies, clinical and subclinical rejections still occur in many graft recipients with a negative impact on the long-term transplant outcome. The immunological status of the patients awaiting the transplantation is a key factor for these processes. Here we summarize the recent efforts to identify and develop biomarkers and functional assays that allow an individual pretransplant risk assessment.
New sensitive techniques assessing T-cell memory and B-cell activation have been developed. Furthermore, the expression level of soluble and molecular markers reflecting the activation state of the immune system and donor graft intrinsic factors have been shown to influence graft outcome.
A variety of parameters and assays that determine the pretransplant immune activation status has been developed. Some of these assays have already been used prospectively to define high-risk patients receiving advanced immunosuppressive induction therapy.However, the conflicting results obtained in different studies show that biomarker analysis and functional assays performance need to be further standardized and validated in large prospective trials before they can be routinely implemented into a pretransplant risk assessment. Subsequently, a combined effort to design pretransplant risk stratification algorithms should lead to personalized immunosuppressive treatment regimes and improved graft survival and long-term graft function.
尽管引入了先进的免疫抑制药物治疗，但许多移植受者仍会发生临床和亚临床排斥反应，这对长期移植结果产生负面影响。患者在等待移植时的免疫状态是这些过程的关键因素。在这里，我们总结了最近在识别和开发生物标志物和功能检测方面的努力，这些方法可以实现个体移植前的风险评估。
已经开发出了新的评估 T 细胞记忆和 B 细胞激活的敏感技术。此外，反映免疫系统激活状态和供体移植物内在因素的可溶性和分子标志物的表达水平也被证明会影响移植物的预后。
已经开发出了多种用于确定移植前免疫激活状态的参数和检测方法。其中一些检测方法已经前瞻性地用于定义接受高级免疫抑制诱导治疗的高危患者。然而，不同研究中得到的相互矛盾的结果表明，生物标志物分析和功能检测的性能需要在大型前瞻性试验中进一步标准化和验证，然后才能常规用于移植前风险评估。随后，设计移植前风险分层算法的共同努力应导致个性化的免疫抑制治疗方案，并改善移植物的存活率和长期移植物功能。
