Jager Neeltina M, Poppelaars Felix, Daha Mohamed R, Seelen Marc A
Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Mol Immunol. 2017 Sep;89:22-35. doi: 10.1016/j.molimm.2017.05.014. Epub 2017 May 27.
Renal transplantation is the treatment of choice for patients with end-stage renal disease. The vital role of the complement system in renal transplantation is widely recognized. This review discusses the role of complement in the different phases of renal transplantation: in the donor, during preservation, in reperfusion and at the time of rejection. Here we examine the current literature to determine the importance of both local and systemic complement production and how complement activation contributes to the pathogenesis of renal transplant injury. In addition, we dissect the complement pathways involved in the different phases of renal transplantation. We also review the therapeutic strategies that have been tested to inhibit complement during the kidney transplantation. Several clinical trials are currently underway to evaluate the therapeutic potential of complement inhibition for the treatment of brain death-induced renal injury, renal ischemia-reperfusion injury and acute rejection. We conclude that it is expected that in the near future, complement-targeted therapeutics will be used clinically in renal transplantation. This will hopefully result in improved renal graft function and increased graft survival.
肾移植是终末期肾病患者的首选治疗方法。补体系统在肾移植中的重要作用已得到广泛认可。本综述讨论了补体在肾移植不同阶段的作用：在供体中、保存期间、再灌注时以及排斥反应发生时。在这里，我们研究当前的文献，以确定局部和全身补体产生的重要性，以及补体激活如何促进肾移植损伤的发病机制。此外，我们剖析了肾移植不同阶段所涉及的补体途径。我们还回顾了在肾移植期间已测试的抑制补体的治疗策略。目前正在进行多项临床试验，以评估补体抑制治疗脑死亡所致肾损伤、肾缺血再灌注损伤和急性排斥反应的治疗潜力。我们得出结论，预计在不久的将来，针对补体的治疗方法将在肾移植中临床应用。这有望改善肾移植功能并提高移植存活率。
