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随着免疫抑制剂的不断更新及应用,抗体介导的排斥反应(AMR)正逐渐成为肾移植术后排斥反应发生的主要类型,其发生与供体特异性抗体(DSA)存在密切的关系。DSA不但能介导急性AMR,也能介导慢性排斥反应,此外,即使术前淋巴细胞毒交叉配型阴性结果的患者,也不能排除AMR的发生。所以对于肾移植术后的排斥反应,应特别关注其是否由DSA引起。本文就供体特异性抗体(DSA)概念、DSA介导的AMR发生的机制、DSA介导的AMR诊断、DSA介导的AMR治疗及预防策略进行综述,以期有助于后续的临床和实验研究。
With the continuous update and application of immunosuppressive agents, antibody-mediated rejection (AMR) is gradually becoming the major type of rejection after renal transplantation, and its occurrence is closely related to donor-specific antibody (DSA). DSA not only mediates acute AMR but also mediates chronic rejection. In addition, DSA can not rule out the occurrence of AMR even in patients with preoperative lymphotoxin-negative crossmatch. Therefore, for rejection after renal transplantation, special attention should be given to whether it is caused by DSA. This review summarizes the concept of donor-specific antibody (DSA), the mechanism of DSA-mediated AMR, the diagnosis of DSA-mediated AMR, the treatment of DSA-mediated AMR and the strategy of prevention, in the hope of contributing to subsequent clinical and experimental studies .