Comprehensive Transplant Center, Kidney Transplant Program and Transplant Immunotherapy Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Comprehensive Transplant Center, Kidney Transplant Program and Transplant Immunotherapy Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Br Med Bull. 2015 Jun;114(1):113-25. doi: 10.1093/bmb/ldv013. Epub 2015 May 1.
Desensitization, a term loosely referring to a collection of antibody reduction and B-cell depletional therapies aimed at improving rates of transplantation in highly HLA and ABO-incompatible transplant recipients, has seen significant growth in the last decade. Advancements relate to an increasing unmet medical need for FDA-approved therapies, advancements in antibody detection methodologies and improved renal pathological assessments of antibody-mediated rejection (ABMR).
SOURCES OF DATA, AREAS OF AGREEMENT AND CONTROVERSY: Data reviewed include collective summaries of experience with high-dose intravenous immunoglobulin (IVIG), B-cell depletion with rituximab and the use of plasma exchange with low-dose IVIG. Consensus suggests that these protocols are the most commonly used while experiences with other agents (i.e. bortezomib) are evolving. Controversy exists as to the extent of resources required, expense and outcomes of desensitization protocols.
Here we review and synthesize data from evolving protocols and summarize developments of novel biologics aimed at modification of B-cells, antibodies and complement activation which will likely improve desensitization and treatment of ABMR.
脱敏治疗，一个广义的术语，指的是一系列旨在提高高度 HLA 和 ABO 不相容移植受者移植成功率的抗体减少和 B 细胞耗竭疗法。在过去十年中，它有了显著的发展。这种发展与对 FDA 批准治疗方法的未满足医疗需求的增加、抗体检测方法的进步以及对抗体介导的排斥反应（ABMR）的肾脏病理评估的改善有关。
数据来源、共识和争议领域：审查的数据包括高剂量静脉注射免疫球蛋白（IVIG）、利妥昔单抗 B 细胞耗竭和低剂量 IVIG 联合血浆置换的经验汇总。共识表明，这些方案是最常用的，而其他药物（如硼替佐米）的经验仍在不断发展。关于脱敏方案所需资源的程度、费用和结果存在争议。
在这里，我们回顾和综合了不断发展的方案的数据，并总结了旨在改变 B 细胞、抗体和补体激活的新型生物制剂的发展，这可能会改善脱敏治疗和 ABMR 的治疗效果。
