Grimaldi Vincenzo, Pagano Martina, Moccia Giusi, Maiello Ciro, De Rosa Paride, Napoli Claudio
U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology. Regional Reference Laboratory of Transplant Immunology (LIT) (EFI and ASHI Certifications). Department of Internal Medicine and Specialistics, University of Campania "L. Vanvitelli", Naples, Italy.
Cardiac Transplantation Unit, Department of Cardiac Surgery and Transplantation, Ospedali dei Colli, Naples, Italy.
Curr Res Immunol. 2023 Jan 23;4:100056. doi: 10.1016/j.crimmu.2023.100056. eCollection 2023.
Despite improvements in anti-Human Leucocyte Antigens antibody detection, identification, and characterization offer a better in peri-operative management techniques, antibodies remain a serious cause of morbidity and mortality for patients both before and after organ transplantation. Hyperimmune patients are disadvantaged by having to wait longer to receive an organ from a suitably matched donor. They could benefit from desensitization protocols in both pre- and post-transplantation period. Clinical studies are underway to highlight which best desensitization strategies could be assure the best outcome in both heart and kidney transplantation. Although most clinical evidence about desensitization strategies by using anti-CD20 monoclonal antibodies, proteasome inhibitors, anti-CD38 monoclonal antibodies, interleukin-6 blockade, cysteine protease and complement inhibitors, comes from kidney transplantation studies, many of the debated novel concepts can be easily applied to desensitization also in heart transplantation. Here, we discuss the candidates and recipients' management by using most common standard of care and novel therapeutics, desensitization endpoints, and strategies for future studies.
尽管抗人类白细胞抗原抗体检测、鉴定和表征在围手术期管理技术方面有所改进，但抗体仍然是器官移植前后患者发病和死亡的严重原因。高免疫患者因需要等待更长时间才能从匹配的供体获得器官而处于不利地位。他们在移植前和移植后的时期都可以从脱敏方案中受益。正在进行临床研究以突出哪种最佳脱敏策略可以确保心脏和肾脏移植的最佳结果。虽然大多数关于使用抗CD20单克隆抗体、蛋白酶体抑制剂、抗CD38单克隆抗体、白细胞介素-6阻断、半胱氨酸蛋白酶和补体抑制剂进行脱敏策略的临床证据来自肾脏移植研究，但许多有争议的新概念也可以很容易地应用于心脏移植的脱敏。在这里，我们讨论使用最常见的标准护理和新型疗法、脱敏终点以及未来研究策略对候选者和接受者的管理。
