Department of Surgery, The Immunology Institute, Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY, USA.
Am J Transplant. 2010 May;10(5):1143-8. doi: 10.1111/j.1600-6143.2010.03033.x. Epub 2010 Feb 25.
Despite the many advances in both immunological knowledge and the practical application of clinical immunosuppression, the holy grail of indefinite graft survival with immune tolerance in clinical solid organ transplantation remains a distant dream. The tremendous progress made in understanding the molecular and cellular basis of allograft rejection has not been translated into durable modalities that have advanced clinical care and outcomes. Indeed, currently used drugs and treatment protocols, largely directed at inhibiting alloreactive T cells, have not optimally improved allograft survival or function. A shift in emphasis, focusing on under appreciated immune pathways must now be considered to make further improvement. We highlight three areas of recent interest, complement, NK cells and lymphatics, which reinforce the concept that the transplant community must direct attention on how the immune system as a whole responds to a transplant. The current challenge is to integrate molecular, cellular and anatomic concepts to achieve the equivalent of a unified field theory of the immune response to organ transplants.
尽管在免疫学知识和临床免疫抑制的实际应用方面取得了许多进展，但在临床实体器官移植中实现无限期移植物存活和免疫耐受的圣杯仍然是一个遥远的梦想。在理解同种异体移植排斥的分子和细胞基础方面取得的巨大进展尚未转化为能够改善临床护理和结果的持久模式。事实上，目前使用的药物和治疗方案主要针对抑制同种反应性 T 细胞，并没有最佳地改善移植物的存活或功能。现在必须考虑将重点转移到关注被低估的免疫途径上，以取得进一步的改善。我们强调了最近引起关注的三个领域，补体、NK 细胞和淋巴管，这强化了这样一个概念，即移植界必须关注免疫系统整体对移植的反应。当前的挑战是整合分子、细胞和解剖学概念，以实现对器官移植免疫反应的统一场论的等效。
