aDivision of Nephrology and Transplantation, Department of Medicine, London Health Sciences Center, The University of Western Ontario, London, Ontario, Canada bDepartment of Medicine cDepartment of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Curr Opin Nephrol Hypertens. 2013 Nov;22(6):681-8. doi: 10.1097/MNH.0b013e328365b3b9.
Humoral sensitization to antigens of the human leukocyte antigen and ABO systems remains one of the largest barriers to further expansion in renal transplantation. This barrier translates into prolonged waiting time and a greater likelihood of death. The number of highly sensitized patients on the renal transplant waiting list continues to increase. This review focuses on the options available to these patients and speculates on future directions for incompatible transplantation.
Desensitization protocols (to remove antibodies), kidney-paired donation (to circumvent antibodies) or a hybrid technique involving a combination of both have broadened the access to transplantation for patients disadvantaged by immunologic barriers. However, the risk of antibody-mediated rejection may be increased and warrants caution. Technical advances in antibody characterization using sensitive bead immunoassays and the C1q assay and therapeutic modalities such as complement inhibitors and proteasome inhibitors have been used to avoid or confront these antibody incompatibilities.
A growing body of knowledge and literature indicates that these diagnostic and therapeutic modalities can facilitate a safer and more successful treatment course for these difficult-to-treat patients. Rigorous investigations into newer interventions will help in broadening the options for these patients and also expand the living donor pool.
对人类白细胞抗原和 ABO 系统抗原的体液致敏仍然是肾移植进一步扩展的最大障碍之一。这一障碍导致等待时间延长，死亡风险增加。在肾移植等待名单上的高度致敏患者数量继续增加。本文重点介绍了这些患者的可选方案，并推测了不相容移植的未来方向。
脱敏方案（去除抗体）、配对供肾（规避抗体）或两者结合的混合技术拓宽了免疫障碍患者接受移植的途径。然而，抗体介导排斥反应的风险可能增加，需要谨慎。使用敏感珠免疫分析和 C1q 分析等技术进步对抗体进行特征描述，以及使用补体抑制剂和蛋白酶体抑制剂等治疗方式，已被用于避免或应对这些抗体不相容性。
越来越多的知识和文献表明，这些诊断和治疗方式可以为这些治疗困难的患者提供更安全、更成功的治疗方案。对新干预措施的严格研究将有助于为这些患者提供更多选择，并扩大活体供者库。
