Roy Sasmit, Chowdhury Monzurul Hasan, Basuli Debargha, Adapa Sreedhar, Bodziak Kenneth
University of Virginia, Lynchburg Dialysis Unit, Lynchburg, VA.
Frank H. Netter M.D. School of Medicine, Department of Internal Medicine, North Haven, CT.
Clin Nephrol Case Stud. 2023 Feb 16;11:12-16. doi: 10.5414/CNCS111030. eCollection 2023.
Graft tolerance is a clinical state of absence of an immune response in the recipient toward a donor allograft without any exogenous immunosuppression. Although more prevalent in liver transplantation recipients, it has rarely been reported in renal transplant recipients. We present a 62-year-old deceased donor kidney transplant recipient who exhibited operational tolerance as they stopped immunosuppressant medications for more than 10 years and yet demonstrated stable graft function. Although various hypotheses, such as deletion, anergy, immunoregulation, and clonal exhaustion, have been experimentally validated, clinical "operational tolerance" of a renal allograft on a prolonged basis has been infrequently reported in the medical literature. This review intends to highlight possible etiologies and make clinicians aware of this possible rare condition to which more research is needed.
移植耐受是指受者在没有任何外源性免疫抑制的情况下，对供体同种异体移植物不产生免疫反应的一种临床状态。虽然在肝移植受者中更为普遍，但在肾移植受者中却很少有报道。我们报告了一名62岁的已故供体肾移植受者，该受者表现出手术耐受，因为他们停用免疫抑制药物超过10年，但移植肾功能仍保持稳定。尽管诸如克隆清除、无反应性、免疫调节和克隆耗竭等各种假说已在实验中得到验证，但医学文献中很少报道肾同种异体移植长期的临床“手术耐受”情况。本综述旨在强调可能的病因，并让临床医生了解这种可能罕见的情况，对此还需要更多的研究。
