Patel Jignesh K, Kobashigawa Jon A
Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
Methods Mol Biol. 2013;1034:127-43. doi: 10.1007/978-1-62703-493-7_7.
Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.
尽管通过有效的免疫抑制技术的发展，胸器官移植已经取得了巨大进展，但在移植后的早期阶段仍存在显著的排斥风险，因此需要对急性抗体介导和细胞介导的排斥反应进行常规监测。目前可用的利用可溶性HLA抗原的多重微珠检测方法能够灵敏地检测和鉴定HLA和非HLA特异性抗体。这些检测方法被用于评估供体特异性抗体的相对强度；进行虚拟交叉配型以减少移植等待时间；在脱敏过程中监测抗体水平；以及用于心脏移植术后监测抗体。对于细胞介导的免疫反应，基因表达谱分析技术的最新发展使得能够对心脏移植受者进行无创监测，从而为急性细胞排斥反应提供预测值。对心脏和肺移植受者的T细胞免疫监测使得免疫抑制能够根据个体情况进行调整，特别是将感染风险降至最低。虽然目前的抗体和细胞实验室技术提高了管理胸器官移植受者的能力，但随着对微嵌合体和移植物耐受性的进一步了解，未来可能会出现更精细的同种异体移植监测技术。
