Department of Transplantation, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
Institute for Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany.
Nat Rev Nephrol. 2018 Dec;14(12):767-781. doi: 10.1038/s41581-018-0071-x.
Increasing evidence indicates an integral role for the complement system in the deleterious inflammatory reactions that occur during critical phases of the transplantation process, such as brain or cardiac death of the donor, surgical trauma, organ preservation and ischaemia-reperfusion injury, as well as in humoral and cellular immune responses to the allograft. Ischaemia is the most common cause of complement activation in kidney transplantation and in combination with reperfusion is a major cause of inflammation and graft damage. Complement also has a prominent role in antibody-mediated rejection (ABMR) owing to ABO and HLA incompatibility, which leads to devastating damage to the transplanted kidney. Emerging drugs and treatment modalities that inhibit complement activation at various stages in the complement cascade are being developed to ameliorate the damage caused by complement activation in transplantation. These promising new therapies have various potential applications at different stages in the process of transplantation, including inhibiting the destructive effects of ischaemia and/or reperfusion injury, treating ABMR, inducing accommodation and modulating the adaptive immune response.
越来越多的证据表明，补体系统在移植过程的关键阶段发生的有害炎症反应中起着重要作用，如供体的脑或心脏死亡、手术创伤、器官保存和缺血再灌注损伤，以及对同种异体移植物的体液和细胞免疫反应。缺血是肾移植中补体激活的最常见原因，与再灌注结合是炎症和移植物损伤的主要原因。补体在抗体介导的排斥反应（ABMR）中也起着重要作用，因为 ABO 和 HLA 不相容导致对移植肾的破坏性损伤。目前正在开发各种抑制补体级联反应各个阶段的补体激活的药物和治疗方法，以减轻补体激活对移植造成的损害。这些有前途的新疗法在移植过程的不同阶段有各种潜在的应用，包括抑制缺血和/或再灌注损伤的破坏性影响、治疗 ABMR、诱导适应和调节适应性免疫反应。
