Renal Institute of Birmingham, Queen Elizabeth Hospital, Edgbaston, Mindelsohn Way, Birmingham, B15 2WB, UK.
QJM. 2012 Dec;105(12):1141-50. doi: 10.1093/qjmed/hcs154. Epub 2012 Aug 20.
Live kidney donor transplantation across immunological barriers, either blood group or positive crossmatch [ABO- and human leucocyte antigens (HLA)-incompatible kidney transplantation, respectively], is now practised widely across many transplant centres. This provides transplantation opportunities to patients that hitherto would have been deemed contra-indicated and would subsequently have waited indefinitely for a suitably matched kidney. Protocols have evolved with time as experience has grown and now a variety of desensitization strategies are currently practised to overcome such immunological barriers. In addition, desensitization protocols are complemented by kidney paired donation exchange schemes and therefore incompatible patients now have strategies to either confront or bypass immunological barriers, respectively. As the field expands it is clear that non-transplant clinicians will be exposed to incompatible kidney transplant recipients outside of experienced centres. It is therefore timely to review the evolution of practice that have led to current desensitization modalities, contrast protocols and outcomes of current regimens and speculate on future direction of incompatible kidney transplantation.
活体肾脏捐献移植跨越免疫障碍，无论是血型还是阳性交叉配型（分别为 ABO 和人类白细胞抗原 [HLA]-不相容的肾脏移植），现在在许多移植中心广泛开展。这为以前被认为禁忌的患者提供了移植机会，否则他们将无限期等待合适配型的肾脏。随着经验的积累，方案也在不断发展，现在有多种脱敏策略被用于克服这种免疫障碍。此外，脱敏方案还辅以肾脏配对捐赠交换计划，因此不相容的患者现在有策略来应对或绕过免疫障碍。随着该领域的扩展，很明显，非移植临床医生将在经验丰富的中心之外接触到不相容的肾脏移植受者。因此，及时审查导致当前脱敏方式、对比方案以及当前方案结果的实践演变，并推测不相容肾脏移植的未来方向是适时的。
