Hope Christopher Martin, Coates Patrick Toby H, Carroll Robert Peter
Christopher Martin Hope, Patrick Toby H Coates, Robert Peter Carroll, Centre for Clinical and Experimental Transplantation, Central Northern Adelaide Renal and Transplantation Services, Adelaide SA 5000, Australia.
World J Nephrol. 2015 Feb 6;4(1):41-56. doi: 10.5527/wjn.v4.i1.41.
Half of all long-term (> 10 year) australian kidney transplant recipients (KTR) will develop squamous cell carcinoma (SCC) or solid organ cancer (SOC), making cancer the leading cause of death with a functioning graft. At least 30% of KTR with a history of SCC or SOC will develop a subsequent SCC or SOC lesion. Pharmacological immunosuppression is a major contributor of the increased risk of cancer for KTR, with the cancer lesions themselves further adding to systemic immunosuppression and could explain, in part, these phenomena. Immune profiling includes; measuring immunosuppressive drug levels and pharmacokinetics, enumerating leucocytes and leucocyte subsets as well as testing leucocyte function in either an antigen specific or non-specific manner. Outputs can vary from assay to assay according to methods used. In this review we define the rationale behind post-transplant immune monitoring assays and focus on assays that associate and/or have the ability to predict cancer and rejection in the KTR. We find that immune monitoring can identify those KTR of developing multiple SCC lesions and provide evidence they may benefit from pharmacological immunosuppressive drug dose reductions. In these KTR risk of rejection needs to be assessed to determine if reduction of immunosuppression will not harm the graft.
在澳大利亚，一半的长期（超过10年）肾移植受者（KTR）会发生鳞状细胞癌（SCC）或实体器官癌（SOC），这使得癌症成为移植肾功能正常情况下的主要死因。至少30%有SCC或SOC病史的KTR会出现后续的SCC或SOC病变。药物免疫抑制是KTR患癌风险增加的主要因素，而癌症病变本身又会进一步加重全身免疫抑制，这在一定程度上可以解释这些现象。免疫分析包括：测量免疫抑制药物水平和药代动力学，计数白细胞及其亚群，以及以抗原特异性或非特异性方式检测白细胞功能。根据所使用的方法不同，各检测的结果也会有所差异。在本综述中，我们阐述了移植后免疫监测检测的基本原理，并重点关注那些与KTR中的癌症和排斥反应相关及/或有能力预测癌症和排斥反应的检测。我们发现免疫监测可以识别出有发生多个SCC病变风险的KTR，并提供证据表明他们可能受益于免疫抑制药物剂量的降低。对于这些KTR，需要评估排斥反应风险，以确定免疫抑制的降低是否不会损害移植肾。
