Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Mol Diagn Ther. 2010 Feb 1;14(1):1-11. doi: 10.1007/BF03256348.
In recent decades, continuous improvements in immunosuppressive therapy have led to a significant increase in kidney allograft survival. Despite innovative developments and improvements in immunosuppression, chronic allograft injury and late graft loss still remain major causes of morbidity and mortality. In clinical practice, long-term immunosuppression is adapted and fine-tuned according to drug levels, kidney function, and biopsy results. As an invasive procedure, indication biopsy still represents an indispensible diagnostic gold standard. However, in an effort to further improve outcomes on the basis of individualized treatment, there is an urgent need for noninvasive assays, as well as biomarkers, to more accurately monitor allogeneic responses and predict the risk of acute and chronic allograft rejection. This article discusses strategies for immune monitoring of T-cell responsiveness and humoral alloreactivity. Furthermore, new microarray and gene profiling data are highlighted, which may identify hyporesponsive transplant recipients who could benefit from a reduction or even withdrawal of immunosuppression. Finally, supplementary transplant risk assessment markers, such as soluble CD30 and urinary effector molecule analysis, are discussed as promising new tools. Recent developments and improvements in test principles to monitor and predict allograft immunity are encouraging and may herald the transition of present empiric immunosuppression to individualized immunosuppressive treatment. Nonetheless, before implementation of immune monitoring in routine clinical practice, there is still a need for prospective trials designed to clarify the actual diagnostic potential of individual test systems in a therapeutic context.
近几十年来，免疫抑制治疗的不断改进导致肾移植存活率显著提高。尽管在免疫抑制方面有创新性的发展和改进，但慢性移植物损伤和晚期移植物丢失仍然是发病率和死亡率的主要原因。在临床实践中，根据药物水平、肾功能和活检结果，长期免疫抑制治疗需要进行适应性调整和精细调整。作为一种有创性操作，指示性活检仍然是不可或缺的诊断金标准。然而，为了在个体化治疗的基础上进一步提高疗效，迫切需要非侵入性检测以及生物标志物，以更准确地监测同种异体反应并预测急性和慢性移植物排斥的风险。本文讨论了监测 T 细胞反应性和体液同种异体反应性的免疫监测策略。此外，还强调了新的微阵列和基因谱数据，这些数据可能识别出对免疫抑制反应较低的移植受者，他们可能受益于减少甚至停止免疫抑制治疗。最后，讨论了可溶性 CD30 和尿效应分子分析等补充移植风险评估标志物作为有前途的新工具。监测和预测移植物免疫的检测原理的最新进展和改进令人鼓舞，可能预示着目前经验性免疫抑制向个体化免疫抑制治疗的转变。然而，在将免疫监测纳入常规临床实践之前，仍需要进行前瞻性试验，以阐明在治疗背景下各个检测系统的实际诊断潜力。
