Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Second Affiliated Hospital, University of South China, Hengyang City, China.
Xenotransplantation. 2018 May;25(3):e12393. doi: 10.1111/xen.12393. Epub 2018 Apr 14.
An important question in xenotransplantation is whether an allotransplant can safely be carried out in a patient who has become sensitized to a pig xenograft. To answer this question, we have searched the literature. We primarily limited our review to the clinically relevant pig-to-non-human primate (NHP) model and found five studies that explored this topic. No NHP that had received a pig graft developed antibodies to alloantigens, and in vitro studies indicated no increased humoral and/or cellular alloreactivity. We carried out a small in vitro study ourselves that confirmed this conclusion. There have been three experiments in which patients undergoing dialysis were exposed to wild-type pig kidneys and three clinical studies related to bridging a patient in hepatic failure to liver allotransplantation. Despite the development of anti-pig antibodies, all subsequent organ (kidney or liver) allografts were successful (except possibly in one case). In addition, pig fetal islets were transplanted into patients with kidney allografts; there was no increase in panel-reactive alloantibodies and the kidney grafts continued to function satisfactorily. In conclusion, the limited data suggest that, after sensitization to pig antigens, there is no evidence of antibody-mediated or accelerated cellular rejection of a subsequent allograft.
异种移植中一个重要的问题是，对于已经对猪异种移植物产生致敏的患者，是否可以安全地进行同种异体移植。为了回答这个问题，我们查阅了文献。我们主要将综述范围限于临床相关的猪到非人类灵长类动物（NHP）模型，并发现了五项探讨这一主题的研究。没有接受猪移植物的 NHP 会产生针对同种异体抗原的抗体，体外研究表明体液和/或细胞同种异体反应性没有增加。我们自己进行了一项小型体外研究，证实了这一结论。有三项实验将接受透析的患者暴露于野生型猪肾脏，还有三项与桥接肝衰竭患者进行肝同种异体移植相关的临床研究。尽管产生了抗猪抗体，但所有随后的器官（肾脏或肝脏）同种异体移植物均成功（除了一个可能的病例）。此外，将猪胎胰岛移植到接受肾同种异体移植的患者中；没有增加面板反应性同种异体抗体，并且肾脏移植物继续功能良好。总之，有限的数据表明，在对猪抗原致敏后，没有证据表明随后的同种异体移植物会发生抗体介导或加速的细胞排斥反应。
