Venkataraman Karthik, Salehi Tania, Carroll Robert P
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia; Australian Red Cross Lifeblood Service, Department of Health Sciences, University of South Australia, Adelaide, Australia.
Semin Nephrol. 2024 Jan;44(1):151500. doi: 10.1016/j.semnephrol.2024.151500. Epub 2024 Mar 27.
Kidney transplant recipients are at increased risk of malignancy as a result of immunosuppression and are increasingly exposed to checkpoint inhibitors (CPIs). However, CPI therapy can precipitate allograft rejection. This review aims to summarize the current literature describing the epidemiology, immunological mechanisms, diagnosis, and treatment of CPI-associated allograft rejection.Initial studies of CPIs suggested allograft rejection post commencement of CPIs occured commonly (40-60%), occurring between 2 and 6 weeks after CPI initiation, with a cancer response rate approaching 50%. More recent studies with predefined, structured immunosuppressive regimens have seen rejection rates of 0-12.5%, with rejection occurring later. Allograft biopsy remains the mainstay of diagnosis; however, noninvasive tools are emerging, including donor-derived cell-free DNA, urinary chemokine assessment, and defining alloreactive T-cell clones prior to or during CPI therapy.
肾移植受者由于免疫抑制而患恶性肿瘤的风险增加，并且越来越多地接触到免疫检查点抑制剂（CPI）。然而，CPI治疗可引发移植肾排斥反应。本综述旨在总结目前描述CPI相关移植肾排斥反应的流行病学、免疫机制、诊断和治疗的文献。对CPI的初步研究表明，开始使用CPI后移植肾排斥反应很常见（40%-60%），发生在开始使用CPI后的2至6周之间，癌症缓解率接近50%。最近采用预定义的结构化免疫抑制方案的研究显示排斥率为0%-12.5%，且排斥反应出现得更晚。移植肾活检仍然是诊断的主要方法；然而，包括供体来源的游离DNA、尿趋化因子评估以及在CPI治疗前或治疗期间确定同种异体反应性T细胞克隆等非侵入性工具正在出现。
