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高致敏肾移植受者脱敏治疗的研究进展

徐岳 胡小鹏

徐岳, 胡小鹏. 高致敏肾移植受者脱敏治疗的研究进展[J]. 器官移植, 2021, 12(6): 676-681. doi: 10.3969/j.issn.1674-7445.2021.06.005
引用本文: 徐岳, 胡小鹏. 高致敏肾移植受者脱敏治疗的研究进展[J]. 器官移植, 2021, 12(6): 676-681. doi: 10.3969/j.issn.1674-7445.2021.06.005
Xu Yue, Hu Xiaopeng. Research progress on desensitization therapy for highly sensitized kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2021, 12(6): 676-681. doi: 10.3969/j.issn.1674-7445.2021.06.005
Citation: Xu Yue, Hu Xiaopeng. Research progress on desensitization therapy for highly sensitized kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2021, 12(6): 676-681. doi: 10.3969/j.issn.1674-7445.2021.06.005

高致敏肾移植受者脱敏治疗的研究进展

doi: 10.3969/j.issn.1674-7445.2021.06.005
基金项目: 

国家自然科学基金 81970645

详细信息
    作者简介:

    胡小鹏,医学博士,教授、主任医师、博士研究生导师。现任首都医科大学附属北京朝阳医院泌尿外科副主任、外科教研室主任。兼任中华医学会泌尿外科学分会移植学组委员、北京医学会器官移植分会委员、中国医师协会器官移植医师分会器官捐献专业委员会委员、中国医疗保健国际交流促进会肾脏移植分会委员兼副秘书长等职务。兼任《器官移植》杂志通讯编委。2009年至2011年在美国Johns Hopkins大学医学院做博士后研究工作。主持多项国家及省部级科研课题的研究工作

    通讯作者:

    胡小鹏,Email:huxp@ccmu.edu.cn

  • 中图分类号: R617, R392.4

Research progress on desensitization therapy for highly sensitized kidney transplant recipients

More Information
  • 摘要: 人类白细胞抗原(HLA)致敏在过去被认为是肾移植的禁忌证,在过去的30年中,随着脱敏治疗策略和免疫抑制剂的不断进步,越来越多的高致敏患者跨过了这一障碍。然而,高致敏患者肾移植术后仍面临着较高的超急性排斥反应以及抗体介导的排斥反应发生率,制约着高致敏患者肾移植手术的成功及移植物的长期存活。寻找切实有效的脱敏治疗方案是目前器官移植研究的热点问题,本文将从目前的脱敏治疗策略、用于脱敏治疗的新型制剂以及脱敏治疗的获益与风险进行综述,对目前脱敏治疗的方法以及脱敏治疗未来的方向进行讨论,旨在为跨越免疫屏障、提高高致敏患者肾移植手术的成功率及术后受者生活质量提供参考。

     

  • [1] AXELROD DA, SCHNITZLER MA, XIAO H, et al. An economic assessment of contemporary kidney transplant practice[J]. Am J Transplant, 2018, 18(5): 1168-1176. DOI: 10.1111/ajt.14702.
    [2] 黄洁夫. 中国器官移植发展报告(2019)[M]. 北京: 清华大学出版社, 2020.
    [3] HART A, LENTINE KL, SMITH JM, et al. OPTN/SRTR 2019 annual data report: kidney[J]. Am J Transplant, 2021, 21(Suppl 2): 21-137. DOI: 10.1111/ajt.16502.
    [4] JORDAN SC, CHOI J, KAHWAJI J, et al. Progress in desensitization of the highly HLA sensitized patient[J]. Transplant Proc, 2016, 48(3): 802-805. DOI: 10.1016/j.transproceed.2015.11.027.
    [5] CHOI AY, MANOOK M, OLASO D, et al. Emerging new approaches in desensitization: targeted therapies for HLA sensitization[J]. Front Immunol, 2021, 12: 694763. DOI: 10.3389/fimmu.2021.694763.
    [6] ZANATTA E, COZZI M, MARSON P, et al. The role of plasma exchange in the management of autoimmune disorders[J]. Br J Haematol, 2019, 186(2): 207-219. DOI: 10.1111/bjh.15903.
    [7] SPEER C, KÄLBLE F, NUSSHAG C, et al. Outcomes and complications following ABO-incompatible kidney transplantation performed after desensitization by semiselective immunoadsorption - a retrospective study[J]. Transpl Int, 2019, 32(12): 1286-1296. DOI: 10.1111/tri.13482.
    [8] PAVENSKI K, BUCHOLZ M, CHEATLEY PL, et al. The first North American experience using glycosorb immunoadsorption columns for blood group-incompatible kidney transplantation[J]. Can J Kidney Health Dis, 2020, 7: 1-6. DOI: 10.1177/2054358120962586.
    [9] MONTAGUD-MARRAHI E, REVUELTA I, CUCCHIARI D, et al. Successful use of nonantigenspecific immunoadsorption with antihuman Ig-columns in kidney graft antibody-mediated rejection[J]. J Clin Apher, 2020, 35(3): 188-199. DOI: 10.1002/jca.21779.
    [10] JAMBON F, MERVILLE P, GUIDICELLI G, et al. Efficacy of plasmapheresis and semi-selective immunoadsorption for removal of anti-HLA antibodies[J]. J Clin Apher, 2021, 36(3): 291-298. DOI: 10.1002/jca.21858.
    [11] CHAUHAN K, MEHTA AA. Rituximab in kidney disease and transplant[J]. Animal Model Exp Med, 2019, 2(2): 76-82. DOI: 10.1002/ame2.12064.
    [12] SOOD P, HARIHARAN S. Anti-CD20 blocker rituximab in kidney transplantation[J]. Transplantation, 2018, 102(1): 44-58. DOI: 10.1097/TP.0000000000001849.
    [13] GENBERG H, HANSSON A, WERNERSON A, et al. Pharmacodynamics of rituximab in kidney allotransplantation[J]. Am J Transplant, 2006, 6(10): 2418-2428. DOI: 10.1111/j.1600-6143.2006.01497.x.
    [14] KAEGI C, WUEST B, SCHREINER J, et al. Systematic review of safety and efficacy of rituximab in treating immune-mediated disorders[J]. Front Immunol, 2019, 10: 1990. DOI: 10.3389/fimmu.2019.01990.
    [15] GALEOTTI C, KAVERI SV, BAYRY J. IVIG-mediated effector functions in autoimmune and inflammatory diseases[J]. Int Immunol, 2017, 29(11): 491-498. DOI: 10.1093/intimm/dxx039.
    [16] PERROTTET N, FERNÁNDEZ-RUIZ M, BINET I, et al. Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: a nationwide cohort study[J]. PLoS One, 2021, 16(4): e0250829. DOI: 10.1371/journal.pone.0250829.
    [17] MADDUR MS, STEPHEN-VICTOR E, DAS M, et al. Regulatory T cell frequency, but not plasma IL-33 levels, represents potential immunological biomarker to predict clinical response to intravenous immunoglobulin therapy[J]. J Neuroinflammation, 2017, 14(1): 58. DOI: 10.1186/s12974-017-0818-5.
    [18] STEGALL MD, GLOOR J, WINTERS JL, et al. A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody[J]. Am J Transplant, 2006, 6(2): 346-351. DOI: 10.1111/j.1600-6143.2005.01178.x.
    [19] ABU JAWDEH BG, CUFFY MC, ALLOWAY RR, et al. Desensitization in kidney transplantation: review and future perspectives[J]. Clin Transplant, 2014, 28(4): 494- 507. DOI: 10.1111/ctr.12335.
    [20] COLLIN M, BJÖRCK L. Toward clinical use of the IgG specific enzymes IdeS and EndoS against antibodymediated diseases[J]. Methods Mol Biol, 2017, 1535: 339- 351. DOI: 10.1007/978-1-4939-6673-8_23.
    [21] LORANT T, BENGTSSON M, EICH T, et al. Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients[J]. Am J Transplant, 2018, 18(11): 2752-2762. DOI: 10.1111/ajt.14733.
    [22] KJELLMAN C, MALDONADO AQ, SJÖHOLM K, et al. Outcomes at 3 years post-transplant in imlifidasedesensitized kidney transplant patients[J]. Am J Transplant, 2021, DOI: 10.1111/ajt.16754[Epubaheadofprint].
    [23] SLATINSKA J, SLAVCEV A, HONSOVA E, et al. Efficacy and safety of bortezomib treatment for refractory acute antibody-mediated rejection-a pilot study[J]. HLA, 2018, 92(Suppl 2): 47-50. DOI: 10.1111/tan.13387.
    [24] PEARL MH, NAYAK AB, ETTENGER RB, et al. Bortezomib may stabilize pediatric renal transplant recipients with antibody-mediated rejection[J]. Pediatr Nephrol, 2016, 31(8): 1341-1348. DOI: 10.1007/s00467-016-3319-3.
    [25] WOODLE ES, SHIELDS AR, EJAZ NS, et al. Prospective iterative trial of proteasome inhibitor-based desensitization[J]. Am J Transplant, 2015, 15(1): 101-118. DOI: 10.1111/ajt.13050.
    [26] JEONG JC, JAMBALDORJ E, KWON HY, et al. Desensitization using bortezomib and highdose immunoglobulin increases rate of deceased donor kidney transplantation[J]. Medicine (Baltimore), 2016, 95(5): e2635. DOI: 10.1097/MD.0000000000002635.
    [27] ESKANDARY F, REGELE H, BAUMANN L, et al. A randomized trial of bortezomib in late antibody-mediated kidney transplant rejection[J]. J Am Soc Nephrol, 2018, 29(2): 591-605. DOI: 10.1681/ASN.2017070818.
    [28] MORENO GONZALES MA, GANDHI MJ, SCHINSTOCK CA, et al. 32 doses of bortezomib for desensitization is not well tolerated and is associated with only modest reductions in anti-HLA antibody[J]. Transplantation, 2017, 101(6): 1222-1227. DOI: 10.1097/TP.0000000000001330.
    [29] STEGALL MD, DIWAN T, RAGHAVAIAH S, et al. Terminal complement inhibition decreases antibodymediated rejection in sensitized renal transplant recipients[J]. Am J Transplant, 2011, 11(11): 2405-2413. DOI: 10.1111/j.1600-6143.2011.03757.x.
    [30] MARKS WH, MAMODE N, MONTGOMERY RA, et al. Safety and efficacy of eculizumab in the prevention of antibody-mediated rejection in living-donor kidney transplant recipients requiring desensitization therapy: a randomized trial[J]. Am J Transplant, 2019, 19(10): 2876- 2888. DOI: 10.1111/ajt.15364.
    [31] JORDAN SC, CHOI J, KIM I, et al. Interleukin-6, a cytokine critical to mediation of inflammation, autoimmunity and allograft rejection: therapeutic implications of IL-6 receptor blockade[J]. Transplantation, 2017, 101(1): 32-44. DOI: 10.1097/TP.0000000000001452.
    [32] JORDAN SC, AMMERMAN N, CHOI J, et al. Interleukin-6: an important mediator of allograft injury[J]. Transplantation, 2020, 104(12): 2497-2506. DOI: 10.1097/TP.0000000000003249.
    [33] VO AA, CHOI J, KIM I, et al. A phase I/Ⅱ trial of the interleukin-6 receptor-specific humanized monoclonal (tocilizumab) + intravenous immunoglobulin in difficult to desensitize patients[J]. Transplantation, 2015, 99(11): 2356- 2363. DOI: 10.1097/TP.0000000000000741.
    [34] ORANDI BJ, LUO X, MASSIE AB, et al. Survival benefit with kidney transplants from HLA-incompatible live donors[J]. N Engl J Med, 2016, 374(10): 940-950. DOI: 10.1056/NEJMoa1508380.
    [35] MANOOK M, KOESER L, AHMED Z, et al. Post-listing survival for highly sensitised patients on the UK kidney transplant waiting list: a matched cohort analysis[J]. Lancet, 2017, 389(10070): 727-734. DOI: 10.1016/S0140-6736(16)31595-1.
    [36] CLAYTON PA, COATES PT. Are sensitized patients better off with a desensitization transplant or waiting on dialysis?[J]. Kidney Int, 2017, 91(6): 1266-1268. DOI: 10.1016/j.kint.2017.04.004.
    [37] KAHWAJI J, SINHA A, TOYODA M, et al. Infectious complications in kidney-transplant recipients desensitized with rituximab and intravenous immunoglobulin[J]. Clin J Am Soc Nephrol, 2011, 6(12): 2894-2900. DOI: 10.2215/CJN.03710411.
    [38] KO EJ, YU JH, YANG CW, et al. Clinical outcomes of ABO- and HLA-incompatible kidney transplantation: a nationwide cohort study[J]. Transpl Int, 2017, 30(12): 1215-1225. DOI: 10.1111/tri.12979.
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出版历程
  • 收稿日期:  2021-09-01
  • 刊出日期:  2021-11-15

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