HLA et Medecine, "Jean Dausset" Laboratory Network, Hôpital Saint-Louis, Paris, France.
Laboratoire Histocompatibilité, Hôpital Saint-Louis, Paris, France.
Front Med. 2019 Jun;13(3):298-313. doi: 10.1007/s11684-018-0636-x. Epub 2019 Jun 11.
Lung transplantation is increasingly practiced for patients with end-stage lung disease. The successful outcome of solid organ transplantation today is severely impeded by the production of alloantibodies, mainly directed against the protein products of the HLA complex of the organ donor. While the association between antibody mediated rejection and allograft damage has been well established in renal and heart transplantation, it has not yet been well characterized in lung transplantation. This review addresses the question of HLA matching in lung transplantation and current knowledge of the allogenicity of different HLA class I and II antigens. The role of the antibody mediated immune response is discussed as well as the importance of pre-transplant or de novo post-transplant circulating antibodies. Finally, potential mechanisms, which may act individually or in combination, of antibody mediated damage to solid organ transplants are considered.
肺移植越来越多地应用于终末期肺病患者。如今,实体器官移植的成功结果受到同种异体抗体的严重阻碍,这些抗体主要针对器官供体 HLA 复合物的蛋白质产物。虽然抗体介导的排斥反应与肾和心脏移植中的同种异体移植物损伤之间的关联已经得到很好的证实,但在肺移植中尚未得到很好的描述。这篇综述探讨了肺移植中 HLA 配型的问题,以及不同 HLA Ⅰ类和Ⅱ类抗原的同种异体性的现有知识。还讨论了抗体介导的免疫反应的作用,以及移植前或移植后新产生的循环抗体的重要性。最后,考虑了可能单独或联合作用的抗体介导的实体器官移植损伤的潜在机制。