Jordan Stanley C, Choi Jua, Vo Ashley
Comprehensive Transplant Center, Kidney Transplant Program & Transplant Immunotherapy Program, Cedars-Sinai Medical Center, 8900 Beverly Blvd, Los Angeles, CA 90048, USA.
Immunotherapy. 2015;7(4):377-98. doi: 10.2217/imt.15.10.
The application of life-saving transplantation is severely limited by the shortage of organs, and histoincompatibility. To increase transplant rates in sensitized patients, new protocols for HLA and blood type incompatible (ABOi) desensitization have emerged. These approaches require significant desensitization using intravenous immunoglobulin, rituximab and plasma exchange. In addition, the development of donor-specific antibody responses post transplant is the major cause of allograft failure with return to dialysis. This increases patient morbidity/mortality and cost. Immunotherapeutic agents used for desensitization evolved from drug development in oncology and autoimmune diseases. Currently, there is a renaissance in development of novel drugs likely to improve antibody reduction in transplantation. These include agents that inactivate IgG molecules, anticytokine antibodies, costimulatory molecule blockade, anticomplement agents and therapies aimed at the plasma cell.
挽救生命的移植应用因器官短缺和组织相容性问题而受到严重限制。为了提高致敏患者的移植率，出现了针对HLA和血型不相容（ABOi）脱敏的新方案。这些方法需要使用静脉注射免疫球蛋白、利妥昔单抗和血浆置换进行大量脱敏。此外，移植后供体特异性抗体反应的发展是导致同种异体移植失败并重新进行透析的主要原因。这增加了患者的发病率/死亡率和成本。用于脱敏的免疫治疗药物源于肿瘤学和自身免疫性疾病的药物研发。目前，新型药物的研发正在复兴，这些药物可能会改善移植中抗体的减少情况。这些药物包括使IgG分子失活的药物、抗细胞因子抗体、共刺激分子阻断剂、抗补体药物以及针对浆细胞的疗法。
