Kulkarni Hrishikesh S, Bemiss Bradford C, Hachem Ramsey R
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8052, Saint Louis, MO 63108, Tel: (314) 454-8762.
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8052, Saint Louis, MO 63108, Tel: (314) 454-8766.
Curr Transplant Rep. 2015 Dec;2(4):316-323. doi: 10.1007/s40472-015-0074-5. Epub 2015 Sep 30.
There has been increasing awareness of antibody-mediated rejection (AMR) as an important cause of graft failure after lung transplantation in recent years. However, the diagnostic criteria for pulmonary AMR are not well defined. All four tenets of AMR in kidney and heart transplantation, graft dysfunction, complement component deposition, circulating donor-specific antibodies (DSA), and histopathologic changes consistent with AMR, are infrequently present in lung transplantation. Nonetheless, the lung transplant community has made important progress recognizing cases of AMR and developing a definition. However, AMR is often refractory to therapy resulting in graft failure and death. In this review, we discuss the progress and challenges in the diagnosis and therapeutic options for pulmonary AMR. In addition, we briefly examine emerging paradigms of C4d-negative AMR and chronic AMR, and conclude that significant progress is needed to mitigate the effects of humoral immune responses after lung transplantation.
近年来，抗体介导的排斥反应（AMR）作为肺移植后移植物功能衰竭的一个重要原因，已受到越来越多的关注。然而，肺AMR的诊断标准尚未明确界定。肾移植和心脏移植中AMR的所有四个原则，即移植物功能障碍、补体成分沉积、循环供体特异性抗体（DSA）以及与AMR一致的组织病理学变化，在肺移植中很少出现。尽管如此，肺移植界在识别AMR病例和制定定义方面取得了重要进展。然而，AMR通常对治疗具有难治性，可导致移植物功能衰竭和死亡。在本综述中，我们讨论了肺AMR诊断和治疗选择方面的进展与挑战。此外，我们简要探讨了C4d阴性AMR和慢性AMR的新兴模式，并得出结论，需要取得重大进展以减轻肺移植后体液免疫反应的影响。
