George Sajid M, Balogun Rasheed A, Sanoff Scott L
Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
J Clin Apher. 2011;26(5):252-60. doi: 10.1002/jca.20297. Epub 2011 Sep 5.
Kidney transplantation is considered the treatment of choice for most individuals with end-stage kidney disease, as well as the most cost-effective renal replacement therapy for the health care system that serves them. Immunologic sensitization, defined by the presence of antibodies directed against foreign HLA (or so called, donor specific antibodies, or DSA), is a significant barrier to kidney transplantation. Further, the presence of DSA is associated with an increase in the incidence of antibody-mediated rejection and decreased graft survival following transplantation. Therapeutic plasma exchange, an extracorporeal therapy directed at removing plasma proteins, including DSA, has proven to be an important part of a comprehensive strategy to minimize the effect of sensitization before, and following kidney transplantation. As such, it offers the promise of increasing access to transplantation, as well as improving outcomes following transplantation. In this concise narrative review, we describe more specifically the benefits of kidney transplantation, the epidemiology of kidney transplantation in the United States, the clinical significance of anti-HLA antibodies, and the evidence supporting a role for therapeutic plasma exchange before and after kidney transplantation.
肾移植被认为是大多数终末期肾病患者的首选治疗方法，也是为他们提供服务的医疗保健系统中最具成本效益的肾脏替代疗法。免疫致敏是指存在针对外来人类白细胞抗原（或所谓的供体特异性抗体，即DSA）的抗体，这是肾移植的一个重大障碍。此外，DSA的存在与抗体介导的排斥反应发生率增加以及移植后移植物存活率降低有关。治疗性血浆置换是一种旨在去除包括DSA在内的血浆蛋白的体外治疗方法，已被证明是在肾移植前后将致敏影响降至最低的综合策略的重要组成部分。因此，它有望增加移植机会，并改善移植后的结果。在这篇简明的叙述性综述中，我们更具体地描述了肾移植的益处、美国肾移植的流行病学、抗HLA抗体的临床意义，以及支持治疗性血浆置换在肾移植前后发挥作用的证据。
