Djamali A, Kaufman D B, Ellis T M, Zhong W, Matas A, Samaniego M
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Am J Transplant. 2014 Feb;14(2):255-71. doi: 10.1111/ajt.12589. Epub 2014 Jan 8.
Advances in multimodal immunotherapy have significantly reduced acute rejection rates and substantially improved 1-year graft survival following renal transplantation. However, long-term (10-year) survival rates have stagnated over the past decade. Recent studies indicate that antibody-mediated rejection (ABMR) is among the most important barriers to improving long-term outcomes. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Additionally, new knowledge of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. Still, questions regarding the classification of ABMR, the precision of diagnostic approaches, and the efficacy of various strategies for managing affected patients abound. This review article provides an overview of current thinking and research surrounding the pathophysiology and diagnosis of ABMR, ABMR-related outcomes, ABMR prevention and treatment, as well as possible future directions in treatment.
多模态免疫疗法的进展显著降低了急性排斥反应率，并大幅提高了肾移植后的1年移植肾存活率。然而，在过去十年中，长期（10年）存活率一直停滞不前。最近的研究表明，抗体介导的排斥反应（ABMR）是改善长期预后的最重要障碍之一。近年来，随着检测和量化受者抗HLA抗体产生的技术能力取得重大进展，对急性和慢性ABMR作用的认识也有所发展。此外，与同种异体移植排斥反应和耐受相关的B细胞和浆细胞免疫生物学的新知识也已出现。尽管如此，关于ABMR的分类、诊断方法的准确性以及管理受影响患者的各种策略的疗效等问题仍然很多。本文综述了目前围绕ABMR的病理生理学和诊断、ABMR相关结局、ABMR的预防和治疗以及可能的未来治疗方向的思考和研究。
