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肾移植是终末期肾脏病患者最佳的治疗方法。体内存在高水平的供者特异性抗体(DSA)的致敏受者接受肾移植后,早期体液性排斥反应发生率高、移植物长期存活率低。致敏肾移植受者同种异体抗体主要由终末分化的长寿命浆细胞在骨髓和其他次级淋巴组织中产生。移植后受者对同种异体抗原并不全发生记忆反应,只有不到一半的致敏受者有同种异体抗体水平增加。移植后早期高水平的同种异体抗体产生将导致AHR;移植后的晚期DSA消失可能与预存浆细胞消失,DSA被移植物吸收或血清存在阻断因子等因素相关。明确移植后不同时期同种异体抗体产生的机制,有助于我们设计更好的治疗方案改善致敏受者移植术后的预后。
Kidney transplantation is the best treatment for patients with end-stage renal disease. Sensitized recipients with high levels of donor-specific antibodies (DSA) in vivo have a high incidence of early rejection of the body fluids and low long-term graft survival following kidney transplantation. Allogeneic antibodies to sensitized kidney transplant recipients are predominantly produced by terminally differentiated long-lived plasma cells in the bone marrow and other secondary lymphoid tissues. The recipients did not have a memory response to alloantigen after transplantation, and only less than half of sensitized recipients had increased levels of alloantibodies. High levels of alloantibody production at early posttransplantation will lead to AHR; the disappearance of advanced DSA after transplantation may be related to the disappearance of pre-stored plasma cells, the absorption of DSA by the graft or the presence of a serum blocking factor. To clarify the mechanism of alloantibody production at different stages after transplantation helps us to design better treatment options to improve the prognosis of sensitized recipients after transplantation.