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摘要: 肾移植是终末期肾病的有效替代治疗方法,新型免疫抑制剂的应用极大提高了肾移植受者的存活率。新型免疫抑制剂的广泛应用促进了免疫抑制方案的改善和优化,术后急性排斥反应发生率不断降低和移植物短期存活率不断提高验证了免疫抑制剂发展的巨大成功。然而,其伴随的不良反应也逐渐显现。如何正确、高效、合理地应用免疫抑制剂是临床医师面临的新挑战。现从以T淋巴细胞为靶点的免疫抑制剂、以B淋巴细胞为靶点的免疫抑制剂、以补体为靶点的免疫抑制剂、以细胞因子为靶点的免疫抑制剂、以混合多克隆抗体为靶点的免疫抑制剂以及以多种细胞为靶点的免疫抑制剂的种类及机制等做一综述,从而为免疫抑制剂的选择应用提供理论基础。
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[1] CHEN GD, LAI XQ, KO DS, et al. Comparison of efficacy and safety between rabbit anti-thymocyte globulin and anti-T lymphocyte globulin in kidney transplantation from donation after cardiac death: a retrospective cohort study[J]. Nephrology (Carlton), 2015, 20(8):539-543. DOI: 10.1111/nep.12469. [2] SHISHIDO S, SATOU H, MURAMATSU M, et al. Combination of pulse methylprednisolone infusions with cyclosporine-based immunosuppression is safe and effective to treat recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation[J]. Clin Transplant, 2013, 27(2):E143-E150. DOI: 10.1111/ctr.12079. [3] LAZELLE RA, MCCULLY BH, TERKER AS, et al. Renal deletion of 12 kDa FK506-binding protein attenuates tacrolimus-induced hypertension[J]. J Am Soc Nephrol, 2016, 27(5):1456-1464. DOI: 10.1681/ASN.2015040466. [4] CHUNG BH, KIM KW, YU JH, et al. Decrease of immature B cell and interleukin-10 during early-post-transplant period in renal transplant recipients under tacrolimus based immunosuppression[J]. Transpl Immunol, 2014, 30(4):159-167. DOI: 10.1016/j.trim.2014.03.003. [5] GATHOGO E, HARBER M, BHAGANI S, et al. Impact of tacrolimus compared with cyclosporin on the incidence of acute allograft rejection in human immunodeficiency virus-positive kidney transplant recipients[J]. Transplantation, 2016, 100(4):871-878. DOI: 10.1097/TP.0000000000000879. [6] HO ET, WONG G, CRAIG JC, et al. Once-daily extended-release versus twice-daily standard-release tacrolimus in kidney transplant recipients: a systematic review[J]. Transplantation, 2013, 95(9):1120-1128. DOI: 10.1097/TP.0b013e318284c15b. [7] OKIMURA K, MAETA K, KOBAYASHI N, et al. Characterization of ASKP1240, a fully human antibody targeting human CD40 with potent immunosuppressive effects[J]. Am J Transplant, 2014, 14(6):1290-1299. DOI: 10.1111/ajt.12678. [8] PARAJULI S, MANDELBROT DA, MUTH B, et al. Rituximab and monitoring strategies for late antibody-mediated rejection after kidney transplantation[J]. Transplant Direct, 2017, 3(12):e227. DOI: 10.1097/TXD.0000000000000746. [9] QUERIDO S, WEIGERT A, ADRAGÃO T, et al. Intravenous immunoglobulin and rituximab in HLA highly sensitized kidney transplant recipients[J]. Transplant Proc, 2018, 50(3):723-727. DOI: 10.1016/j.transproceed.2018.02.016. [10] MASOUD S, MCADOO SP, BEDI R, et al. Ofatumumab for B cell depletion in patients with systemic lupus erythematosus who are allergic to rituximab[J]. Rheumatology (Oxford), 2018. DOI:10.1093/rheumatology/key042 [Epubahead of print]. [11] STAHNKE AM, HOLT KM. Ocrelizumab: a new B-cell therapy for relapsing remitting and primary progressive multiple sclerosis[J]. Ann Pharmacother, 2018, 52(5):473-483. DOI: 10.1177/1060028017747635. [12] MARTIN ST, CARDWELL SM, NAILOR MD, et al. Hepatitis B reactivation and rituximab: a new boxed warning and considerations for solid organ transplantation[J]. Am J Transplant, 2014, 14(4):788-796. DOI: 10.1111/ajt.12649. [13] CHAUDHURI A, OZAWA M, EVERLY MJ, et al. The clinical impact of humoral immunity in pediatric renal transplantation[J]. J Am Soc Nephrol, 2013, 24(4):655-664. DOI: 10.1681/ASN.2012070663. [14] 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. [15] REQUIAO-MOURA LR, DE SANDES-FREITAS TV, MARCELO-GOMES G, et al. Bortezomib in kidney transplant: current use and perspectives[J]. Curr Drug Metab, 2017, 18(12):1136-1146. DOI: 10.2174/1389200218666171121100716. [16] PICKERING MC, D'AGATI VD, NESTER CM, et al. C3 glomerulopathy: consensus report[J]. Kidney Int, 2013, 84(6):1079-1089. DOI: 10.1038/ki.2013.377. [17] VALENZUELA NM, MCNAMARA JT, REED EF. Antibody-mediated graft injury: complement-dependent and complement-independent mechanisms[J]. Curr Opin Organ Transplant, 2014, 19(1):33-40. DOI: 10.1097/MOT.0000000000000040. [18] STEGALL MD, DIWAN T, RAGHAVAIAH S, et al. Terminal complement inhibition decreases antibody-mediated rejection in sensitized renal transplant recipients[J]. Am J Transplant, 2011, 11(11):2405-2413. DOI: 10.1111/j.1600-6143.2011.03757.x. [19] WISEMAN AC. Immunosuppressive medications[J]. Clin J Am Soc Nephrol, 2016, 11(2):332-343. DOI: 10.2215/CJN.08570814. [20] VINCENTI F, TEDESCO SILVA H, BUSQUE S, et al. Randomized phase 2b trial of tofacitinib (CP-690, 550) in de novo kidney transplant patients: efficacy, renal function and safety at 1 year[J]. Am J Transplant, 2012, 12(9):2446-2456. DOI: 10.1111/j.1600-6143.2012.04127.x. [21] ATLANI M, SHARMA RK, GUPTA A. Basiliximab induction in renal transplantation: long-term outcome[J]. Saudi J Kidney Dis Transpl, 2013, 24(3):473-479. doi: 10.4103/1319-2442.111010 [22] GELFAND EW. Intravenous immune globulin in autoimmune and inflammatory diseases[J]. N Engl J Med, 2012, 367(21):2015-2025. DOI: 10.1056/NEJMra1009433. [23] JORDAN SC, TOYODA M, KAHWAJI J, et al. Clinical aspects of intravenous immunoglobulin use in solid organ transplant recipients[J]. Am J Transplant, 2011, 11(2):196-202. DOI: 10.1111/j.1600-6143.2010.03400.x. [24] YAPRAK M, DOǦRU V, SANHAL CY, et al. Fertility outcome after renal transplantation: a single-center experience[J]. Transplant Proc, 2019, 51(4):1108-1111. DOI: 10.1016/j.transproceed.2019.01.111. [25] ZHENG J, SONG W. Alemtuzumab versus antithymocyte globulin induction therapies in kidney transplantation patients: a systematic review and Meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2017, 96(28):e7151. DOI: 10.1097/MD.0000000000007151. [26] YANG A, WANG B. Sirolimus versus tacrolimus in kidney transplant recipients receiving mycophenolate mofetil and steroids: focus on acute rejection, patient and graft survival[J]. Am J Ther, 2015, 22(2):98-104. DOI: 10.1097/MJT.0b013e31827ab584. [27] TAYLOR EB, RYAN MJ. Immunosuppression with mycophenolate mofetil attenuates hypertension in an experimental model of autoimmune disease[J]. J Am Heart Assoc, 2017, 6(3): e005394. DOI: 10.1161/JAHA.116.005394. [28] 于立新, 周敏捷, 罗敏.肾移植受者应用霉酚酸酯的合理治疗窗[J].南方医科大学学报, 2014, (12):1842-1845. DOI: 10.3969/j.issn.1673-4254.2014.12.29.YU LX, ZHOU MJ, LUO M. Therapeutic window of mycophenolate mofetil for preventing acute graft rejection following renal transplantation[J].J South Med Univ, 2014, 34(12):1842-1845. DOI: 10.3969/j.issn.1673-4254.2014.12.29. [29] JAW J, HILL P, GOODMAN D. Combination of leflunomide and everolimus for treatment of BK virus nephropathy[J]. Nephrology (Carlton), 2017, 22(4):326-329. DOI: 10.1111/nep.12948. [30] 周异群.心脏死亡器官捐献肾移植术后肾功能延迟恢复的免疫抑制剂选择[J].复旦学报(医学版), 2018, 45(2):240-244.DOI: 10.3969/j.issn.1672-8467.2018.02.015.ZHOU YQ. Immunosuppressant treatment for delayed graft function in renal transplantion of donation after cardiac death[J]. J Fudan Univ (Med Sci), 2018, 45(2):240-244. DOI: 10.3969/j.issn.1672-8467.2018.02.015. [31] 黄俊, 李剑文, 梁鸣, 等.他克莫司联合激素治疗血清抗PLA2R抗体持续高滴度的难治性特发性膜性肾病[J].实用医学杂志, 2018, 34(8):1355-1359. DOI: 10.3969/j.issn.1006-5725.2018.08.033.HUANG J, LI JW, LIANG M, et al. Tacrolimus combined with prednisone for treatment of refractory idiopathic membranous nephropathy with persistent high serum anti-phospholipase A2 receptor antibody titers[J]. J Pract Med, 2018, 34(8):1355-1359. DOI: 10.3969/j.issn.1006-5725.2018.08.033
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