Opgenoorth Mirian, Wagner Andrea, Passauer Jens, Hohenstein Bernd, Hugo Christian
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany.
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany.
Atheroscler Suppl. 2015 May;18:67-73. doi: 10.1016/j.atherosclerosissup.2015.02.014.
Antibody-mediated rejection (AMR) is associated with poor allograft survival. Therefore, effective treatment strategies are required. Extracorporeal strategies are increasingly included in treatment of antibody-mediated rejection to eliminate the detrimental alloantibodies. Yet, other mechanisms contributing to the beneficial effect of apheresis besides the removal of antibodies are under consideration.
We retrospectively analyzed data of 427 transplant patients from 2006 to 2013 with special focus on occurrence, treatment - always including immunoadsorption - and 12-months outcome of antibody-mediated rejection. Besides, we prospectively monitored how the number and phenotype of endothelial progenitor cells in four patients experiencing antibody-mediated rejection changed during the treatment course of 6-20 sessions of immunoadsorption in comparison to seven patients subjected to immunoadsorption because of preparation for ABO-incompatible transplantation.
24 patients were diagnosed with acute AMR and treated with immunoadsorption resulting in patient and allograft survival of 100% and 87.5%, respectively. In patients with antibody-mediated rejection, the endothelial progenitor cell number after successful immunoadsorption therapy was always transiently decreased and the adhesive and migratory ability improved. This regulation of circulating endothelial precursor cells was not seen in patients undergoing repetitive immunoadsorptions before ABO-incompatible transplantation.
Combined therapy with immunoadsorption allows a successful treatment of AMR. Treatment seems to be associated with a transient regulation of circulating endothelial precursor cells.
抗体介导的排斥反应（AMR）与移植器官的低存活率相关。因此，需要有效的治疗策略。体外治疗策略越来越多地被纳入抗体介导的排斥反应治疗中，以消除有害的同种异体抗体。然而，除了清除抗体之外，其他导致血液成分分离术产生有益效果的机制也在研究之中。
我们回顾性分析了2006年至2013年间427例移植患者的数据，特别关注抗体介导的排斥反应的发生、治疗（始终包括免疫吸附）以及12个月的预后。此外，我们前瞻性监测了4例发生抗体介导的排斥反应的患者在6 - 20次免疫吸附治疗过程中内皮祖细胞数量和表型的变化，并与7例因ABO血型不相容移植准备而接受免疫吸附治疗的患者进行了比较。
24例患者被诊断为急性AMR并接受免疫吸附治疗，患者和移植器官的存活率分别为100%和87.5%。在发生抗体介导的排斥反应的患者中，成功的免疫吸附治疗后内皮祖细胞数量总是短暂减少，黏附能力和迁移能力提高。在ABO血型不相容移植前接受重复免疫吸附治疗的患者中，未观察到循环内皮祖细胞的这种调节情况。
免疫吸附联合治疗可成功治疗AMR。治疗似乎与循环内皮祖细胞的短暂调节有关。
