Department of Pathology, Division of Transplant Pathology, University of Pittsburgh. Pittsburgh, Pennsylvania, USA.
Curr Opin Organ Transplant. 2012 Aug;17(4):416-22. doi: 10.1097/MOT.0b013e328355f1ab.
Desensitization therapies in sensitized patients have been implemented to lower the human leukocyte antigen (HLA) antibody burden and facilitate thoracic transplantation. This review will focus on the characterization of HLA antibodies pre- and post-intervention, to assess the changes in antibody titer and function that might promote transplantation with low risk of early antibody-mediated rejection (AMR).
A steady increase in the proportion of both adult and pediatric sensitized thoracic patients awaiting transplantation has been observed over the last years. Patients with elevated panel reactive antibodies at the time of listing have a poorer outcome compared to nonsensitized patients. Advances in solid phase assays for HLA antibodies have benefited the detection accuracy and characterization of clinically relevant anti-HLA antibodies. Therefore, monitoring the level and function of HLA antibodies following desensitization protocols can be used to determine the success of achieving acceptable antibody levels for safe transplantation and also the risk of AMR.
Allosensitization among candidates considered for thoracic transplantation remains a great challenge. Determining the efficacy of desensitizing protocols by incorporating new tools for monitoring antibody profiles can better stratify a candidate's immunologic risk, thereby increasing the likelihood of transplantation and minimizing AMR.
在致敏患者中实施脱敏治疗以降低人类白细胞抗原 (HLA) 抗体负担并促进胸部移植。本综述将重点关注干预前后 HLA 抗体的特征，以评估可能促进具有低早期抗体介导排斥反应 (AMR) 风险的移植的抗体滴度和功能变化。
过去几年，等待移植的成年和儿科致敏胸部患者的比例稳步增加。与非致敏患者相比，在列入名单时具有高 panel reactive 抗体的患者预后较差。用于 HLA 抗体的固相检测方法的进步提高了检测准确性和对临床相关抗 HLA 抗体的特征描述。因此，监测脱敏方案后 HLA 抗体的水平和功能可用于确定实现可接受的抗体水平以确保安全移植的成功，以及 AMR 的风险。
在考虑进行胸部移植的候选者中同种致敏仍然是一个巨大的挑战。通过结合监测抗体谱的新工具来确定脱敏方案的效果，可以更好地对候选者的免疫风险进行分层，从而增加移植的可能性并最大程度地减少 AMR。
