抗体介导的排斥反应。
Antibody-mediated rejection.
作者信息
Westall Glen P, Paraskeva Miranda A, Snell Greg I
机构信息
Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
出版信息
Curr Opin Organ Transplant. 2015 Oct;20(5):492-7. doi: 10.1097/MOT.0000000000000235.
PURPOSE OF REVIEW
Pulmonary antibody-mediated rejection (AMR) while contributing to acute and chronic allograft dysfunction remains a diagnostic and therapeutic challenge. The diagnostic tenets upon which AMR is defined will be reviewed in the light of recent studies.
RECENT FINDINGS
The introduction of solid phase assays such as the Luminex platform has provided a wealth of quantitative data on the presence of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSA). Further studies are required to better define the relationship of circulating DSA and activation of proinflammatory immune pathways that result in allograft dysfunction. The limitations of C4d staining in defining AMR are highlighted from recent studies in lung transplantation and from the 2013 Banff meeting on renal transplantation.
SUMMARY
The current challenge to the lung transplant community is to agree on a working definition of pulmonary AMR. Only then can we better appreciate the epidemiology, clinical phenotypes, and treatment of AMR.
综述目的
肺抗体介导的排斥反应（AMR）虽会导致急性和慢性移植物功能障碍，但仍是诊断和治疗方面的一大挑战。鉴于近期研究，将对定义AMR的诊断原则进行综述。
最新发现
诸如Luminex平台等固相检测方法的引入，提供了大量关于抗人白细胞抗原（HLA）供体特异性抗体（DSA）存在情况的定量数据。需要进一步研究，以更好地界定循环DSA与导致移植物功能障碍的促炎免疫途径激活之间的关系。肺移植近期研究以及2013年肾移植班夫会议均凸显了C4d染色在定义AMR方面的局限性。
总结
肺移植领域当前面临的挑战是就肺AMR的实用定义达成共识。只有这样，我们才能更好地了解AMR的流行病学、临床表型及治疗方法。
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