Llinàs-Mallol Laura, Raïch-Regué Dàlia, Pascual Julio, Crespo Marta
Department of Nephrology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Transplant Rev (Orlando). 2023 Jan;37(1):100745. doi: 10.1016/j.trre.2022.100745. Epub 2022 Dec 20.
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Although an improvement in graft survival has been observed in the last decades with the use of different immunosuppressive drugs, this is still limited in time with antibody-mediated rejection being a main cause of graft-loss. Immune monitoring and risk assessment of antibody-mediated rejection before and after kidney transplantation with useful biomarkers is key to tailoring treatments to achieve the best outcomes. Here, we provide a review of the rationale and several accessible tools for immune monitoring, from the most classic to the modern ones. Finally, we end up discussing a practical proposal for alloimmune risk assessment in kidney transplantation, including histocompatibility leukocyte antigen (HLA) and non-HLA antibodies, HLA molecular mismatch analysis and characterization of peripheral blood immune cells.
肾移植是终末期肾病患者的首选治疗方法。尽管在过去几十年中，使用不同的免疫抑制药物后移植肾存活率有所提高，但时间上仍有限，抗体介导的排斥反应是移植肾丢失的主要原因。使用有用的生物标志物对肾移植前后抗体介导的排斥反应进行免疫监测和风险评估，是定制治疗方案以实现最佳结果的关键。在此，我们综述了免疫监测的基本原理和几种可获得的工具，从最经典的到现代的。最后，我们讨论了肾移植中同种免疫风险评估的实用建议，包括组织相容性白细胞抗原（HLA）和非HLA抗体、HLA分子错配分析以及外周血免疫细胞的特征。
