Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK.
Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
Eur Respir Rev. 2022 Jul 27;31(165). doi: 10.1183/16000617.0060-2022. Print 2022 Sep 30.
Lung transplantation is the optimal treatment for selected patients with end-stage chronic lung diseases. However, chronic lung allograft dysfunction remains the leading obstacle to improved long-term outcomes. Traditionally, lung allograft rejection has been considered primarily as a manifestation of cellular immune responses. However, in reality, an array of complex, interacting and multifactorial mechanisms contribute to its emergence. Alloimmune-dependent mechanisms, including T-cell-mediated rejection and antibody-mediated rejection, as well as non-alloimmune injuries, have been implicated. Moreover, a role has emerged for autoimmune responses to lung self-antigens in the development of chronic graft injury. The aim of this review is to summarise the immune processes involved in the pathogenesis of chronic lung allograft dysfunction, with advanced insights into the role of innate immune pathways and crosstalk between innate and adaptive immunity, and to identify gaps in current knowledge.
肺移植是治疗特定终末期慢性肺部疾病患者的最佳方法。然而，慢性肺移植物失功仍然是改善长期预后的主要障碍。传统上，肺移植物排斥反应主要被认为是细胞免疫反应的表现。然而，实际上，一系列复杂的、相互作用的和多因素的机制促成了它的出现。同种免疫依赖性机制，包括 T 细胞介导的排斥反应和抗体介导的排斥反应，以及非同种免疫损伤，都与之相关。此外，自身免疫反应对肺自身抗原的反应在慢性移植物损伤的发展中也起到了一定的作用。本文的目的是总结慢性肺移植物失功发病机制中的免疫过程，深入了解先天免疫途径的作用以及先天免疫和适应性免疫之间的相互作用，并确定目前知识中的空白。
