Antibody-mediated rejection in lung transplantation: Myth or reality?
Antibody-mediated rejection in lung transplantation: Myth or reality?
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DOI：
10.1016/j.healun.2010.01.012
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发表时间：
2010-04-01
影响因子：
8.9
通讯作者：
Glanville, Allan R.
中科院分区：
文献类型：
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作者：
Glanville, Allan R.
肺移植后抗体介导的排斥反应是否作为一个实体存在，免疫学家，组织病理学家和临床医生争论不休，尽管有越来越多的证据证明在其他实体器官移植学科中的重要作用，但关于诊断特征没有达成强烈的共识。支持和反对肺移植后抗体介导的排斥反应的多变表现的证据进行了讨论，特别提到超急性肺移植排斥反应以及急性和慢性肺移植排斥反应，强调补体和抗体对人类白细胞抗原和抗内皮抗原的潜在作用。对于超急性肺同种异体移植物排斥反应，存在一种描述良好的临床表型，如果在过程的早期开始，静脉注射免疫球蛋白、血浆置换和抗CD 20单克隆抗体加支持性治疗的疗效证据水平较低。急性抗体介导的排斥反应的临床表型现在被更好地定义，如果没有广泛诊断，类似的治疗方案似乎是有效的。迄今为止，基于一些引人注目的初步工作，抗体介导的排斥反应在慢性肺移植排斥反应发展中的作用仍然是一个令人兴奋的进一步研究领域。肺移植后抗体介导的排斥反应仍然是一个主要的研究领域。在临床领域，经验表明，抗体介导的排斥反应应被认为是移植物功能障碍的潜在原因，无论是否诊断出伴随的急性细胞排斥反应，特别是在遇到对皮质类固醇治疗耐药的情况下。J Heart Lung Transplant 2010;29：395-400（C）2010年国际心肺移植学会。All rights reserved.
Whether antibody-mediated rejection after lung transplantation exists as an entity is debated by immunologists, histopathologists, and clinicians, without a strong consensus regarding diagnostic characteristics despite an increasing body of evidence that attests to a significant role in other solid organ transplant disciplines. Evidence for and against the protean manifestations of antibody-mediated rejection after lung transplantation is discussed, with special reference to hyperacute pulmonary allograft rejection as well as acute and chronic pulmonary allograft rejection, emphasizing the potential role of complement and antibodies to human leukocyte antigens and anti-endothelial antigens. A well-described clinical phenotype exists for hyperacute pulmonary allograft rejection with low-level evidence for efficacy of therapy with intravenous immunoglobulin, plasmapheresis, and anti-CD20 monoclonal antibodies plus supportive care, if instituted early in the evolution of the process. The clinical phenotype of acute antibody-mediated rejection is now better defined, if not widely diagnosed, and a similar treatment protocol appears effective. The role of antibody-mediated rejection in the development of chronic pulmonary allograft rejection remains an exciting area for further study based on some compelling preliminary work to date. Antibody-mediated rejection after lung transplantation remains a major area for research. In the clinical domain, experience suggests antibody-mediated rejection should be considered a potential cause of graft dysfunction, whether concomitant acute cellular rejection is diagnosed or not, and especially where resistance to corticosteroid therapy is encountered. J Heart Lung Transplant 2010;29:395-400 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.