Mannon Roslyn B
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Kidney Int Suppl. 2010 Dec(119):S59-65. doi: 10.1038/ki.2010.425.
Late failure of a kidney transplant continues to be a major problem after transplantation, in spite of more potent immunosuppressive strategies and the focus of clinical management shifting toward prolonging long-term graft survival. It is now recognized that graft failure occurs because of two major complications: death with a functioning graft and intrinsic allograft failure. Recent studies of late kidney graft loss have indicated a complexity of findings, including etiologies that are both immune and non-immune. These studies suggest that late graft failure is not an inevitable fact and that further investigation into the etiology of transplant graft failure may lead to a new understanding of the biology that will provide novel therapeutic strategies and biomarkers. In this review, we will focus on late allograft failure due to intrinsic injury to the transplant. The role of immune monitoring will be discussed in the context of monitoring for ongoing injury or for identifying late injury. A variety of methodologies have been used, including genomics, proteomics, and metabolomics, not only for monitoring allograft injury but also for identifying markers of graft failure that are more sensitive than serum creatinine. The available studies, as they relate to late or chronic graft injury, will also be reviewed.
尽管有更有效的免疫抑制策略，且临床管理重点已转向延长长期移植肾存活时间，但肾移植术后的晚期失败仍是移植后的一个主要问题。现在人们认识到，移植肾失败是由两种主要并发症引起的：移植肾仍有功能时的死亡和移植肾自身的失败。最近关于晚期肾移植丢失的研究表明结果很复杂，包括免疫性和非免疫性病因。这些研究表明，晚期移植肾失败并非不可避免，对移植肾失败病因的进一步研究可能会带来对生物学的新认识，从而提供新的治疗策略和生物标志物。在本综述中，我们将关注因移植肾自身损伤导致的晚期移植肾失败。免疫监测的作用将在监测持续性损伤或识别晚期损伤的背景下进行讨论。已经使用了多种方法，包括基因组学、蛋白质组学和代谢组学，不仅用于监测移植肾损伤，还用于识别比血清肌酐更敏感的移植肾失败标志物。还将对与晚期或慢性移植肾损伤相关的现有研究进行综述。
