Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Transplantation. 2021 Jul 1;105(7):1459-1470. doi: 10.1097/TP.0000000000003551.
Although solid organ transplant results have improved significantly in recent decades, a pivotal cause of impaired long-term outcome is the development of antibody-mediated rejection (AMR), a condition characterized by the presence of donor-specific antibodies to HLA or non-HLA antigens. Highly HLA-sensitized recipients are treated with desensitization protocols to rescue the transplantation. These and other therapies are also applied for the treatment of AMR. Therapeutic protocols include removal of antibodies, depletion of plasma and B cells, inhibition of the complement cascade, and suppression of the T-cell-dependent antibody response. As mounting evidence illustrates the importance of non-HLA antibodies in transplant outcome, there is a need to evaluate the efficacy of treatment protocols on non-HLA antibody levels and graft function. Many reviews have been recently published that provide an overview of the literature describing the association of non-HLA antibodies with rejection in transplantation, whereas an overview of the treatment options for non-HLA AMR is still lacking. In this review, we will therefore provide such an overview. Most reports showed positive effects of non-HLA antibody clearance on graft function. However, monitoring non-HLA antibody levels after treatment along with standardization of therapies is needed to optimally treat solid organ transplant recipients.
尽管近年来实体器官移植的效果有了显著的提高，但导致长期预后受损的一个关键原因是抗体介导的排斥反应（AMR）的发展，其特征是存在针对 HLA 或非 HLA 抗原的供体特异性抗体。高度 HLA 致敏的受者接受脱敏方案治疗以挽救移植。这些和其他疗法也用于治疗 AMR。治疗方案包括清除抗体、耗竭血浆和 B 细胞、抑制补体级联反应以及抑制 T 细胞依赖性抗体反应。随着越来越多的证据表明非 HLA 抗体在移植结果中的重要性，有必要评估治疗方案对非 HLA 抗体水平和移植物功能的疗效。最近发表了许多综述，概述了描述非 HLA 抗体与移植排斥反应之间关系的文献，而对于非 HLA AMR 的治疗选择仍然缺乏概述。因此，在这篇综述中，我们将提供这样的概述。大多数报告显示，清除非 HLA 抗体对移植物功能有积极影响。然而，需要在治疗后监测非 HLA 抗体水平并标准化治疗，以优化治疗实体器官移植受者。
