Antibody-mediated rejection: prevention, monitoring and treatment dilemmas.
Antibody-mediated rejection: prevention, monitoring and treatment dilemmas.
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DOI：
10.1097/mot.0000000000001011
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发表时间：
2022-10-01
影响因子：
2.2
通讯作者：
Riella, Leonardo, V
中科院分区：
文献类型：
--
作者：
Rodriguez-Ramirez, Sonia;Al Jurdi, Ayman;Konvalinka, Ana;Riella, Leonardo, V
抗体介导的排斥反应（AMR）已成为肾移植受者晚期移植物丢失的主要原因。供体特异性抗体是 AMR 和移植物丢失的独立危险因素。然而，并非所有供体特异性抗体都是致病性的。由于缺乏支持临床决策的可靠试验，AMR 治疗存在异质性。这篇综述对医生在管理 AMR 肾移植受者时遇到的实际但相关的困境进行了概述和评论。具有供者特异性抗体的活性 AMR 可以通过血浆置换、静脉注射免疫球蛋白和皮质类固醇进行治疗，并根据具体情况考虑其他疗法。相反，目前还没有任何治疗方法能够有效对抗慢性活动性 AMR。用于评估移植失败的个体风险和排斥治疗反应的各种生物标志物和预测模型显示出了希望。对特定肾移植受者进行个性化管理并确定可改善其长期结果的治疗方法的能力仍然是一个尚未满足的关键需求。应考虑通过非侵入性生物标志物和预测模型尽早识别 AMR，以评估移植失败的个体风险。强烈鼓励将 AMR 患者纳入临床试验以评估新型治疗药物。
Antibody-mediated rejection (AMR) has emerged as the leading cause of late graft loss in kidney transplant recipients. Donor-specific antibodies are an independent risk factor for AMR and graft loss. However, not all donor-specific antibodies are pathogenic. AMR treatment is heterogeneous due to the lack of robust trials to support clinical decisions. This review provides an overview and comments on practical but relevant dilemmas physicians experience in managing kidney transplant recipients with AMR. Active AMR with donor-specific antibodies may be treated with plasmapheresis, intravenous immunoglobulin and corticosteroids with additional therapies considered on a case-by-case basis. On the contrary, no treatment has been shown to be effective against chronic active AMR. Various biomarkers and prediction models to assess the individual risk of graft failure and response to rejection treatment show promise. The ability to personalize management for a given kidney transplant recipient and identify treatments that will improve their long-term outcome remains a critical unmet need. Earlier identification of AMR with noninvasive biomarkers and prediction models to assess the individual risk of graft failure should be considered. Enrolling patients with AMR in clinical trials to assess novel therapeutic agents is highly encouraged.