Diagnosis and management of antibody-mediated rejection: current status and novel approaches.
Diagnosis and management of antibody-mediated rejection: current status and novel approaches.
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DOI：
10.1111/ajt.12589
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发表时间：
2014-02
期刊：
影响因子：
--
通讯作者：
Samaniego M
中科院分区：
文献类型：
--
作者：
Djamali A;Kaufman DB;Ellis TM;Zhong W;Matas A;Samaniego M
多模式免疫治疗的进展显著降低了肾移植后的急性排斥反应率，并显著提高了1年移植物存活率。然而，长期（10年）生存率在过去十年中停滞不前。最近的研究表明，抗体介导的排斥反应（ABMR）是改善长期结局的最重要障碍之一。近年来，随着检测和定量受体抗HLA抗体产生的技术能力的重大进展，对急性和慢性ABMR作用的理解有所提高。此外，与同种异体移植排斥和耐受有关的B细胞和浆细胞的免疫生物学的新知识已经出现。尽管如此，关于ABMR的分类，诊断方法的精确性，以及管理受影响患者的各种策略的有效性的问题比比皆是。这篇综述文章概述了目前围绕ABMR的病理生理学和诊断、ABMR相关结局、ABMR预防和治疗以及未来可能的治疗方向的思考和研究。本文综述了肾移植后抗体介导的排斥反应谱，包括其发病机制，危险因素，表型，修订后的Banff 2013分类，治疗方案和结果。另见第272页哈斯等人的会议报告。
Advances in multimodal immunotherapy have significantly reduced acute rejection rates and substantially improved 1-year graft survival following renal transplantation. However, long-term (10-year) survival rates have stagnated over the past decade. Recent studies indicate that antibody-mediated rejection (ABMR) is among the most important barriers to improving long-term outcomes. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Additionally, new knowledge of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. Still, questions regarding the classification of ABMR, the precision of diagnostic approaches, and the efficacy of various strategies for managing affected patients abound. This review article provides an overview of current thinking and research surrounding the pathophysiology and diagnosis of ABMR, ABMR-related outcomes, ABMR prevention and treatment, as well as possible future directions in treatment. This review addresses the spectrum of antibody-mediated rejection after kidney transplantation, including its pathogenesis, risk factors, phenotypes, the revised Banff 2013 classification, treatment options, and outcomes. Also see meeting report by Haas et al on page 272.
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