Strategies for long-term preservation of kidney graft function
Strategies for long-term preservation of kidney graft function
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DOI：
10.1016/s0140-6736(17)31283-7
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发表时间：
2017-05-27
期刊：
影响因子：
168.9
通讯作者：
Oberbauer, Rainer
中科院分区：
文献类型：
--
作者：
Wekerle, Thomas;Segev, Dorry;Oberbauer, Rainer
肾移植已成为治疗肾衰竭患者的常规手术，需要来自不同学科的专家合作，如肾脏病学、外科、免疫学、病理学、传染病医学、心脏病学和肿瘤学。移植物可以从已故或活体供体获得，但有不同的后勤要求和对移植物长期通畅的影响。在许多中心，1年移植存活率大于95%，但长期功能的改善仍然是一个挑战。分子免疫学和计算生物学的新发展提高了HLA和非HLA相容性的供体和受体匹配的精度。个体组学范围内的分子诊断，体外治疗和药物开发允许精确的个人决策和治疗。无毒性条件和低移植物抗宿主病风险的混合嵌合诱导耐受性是一个有远见但现实的目标。其中一些创新已经在现代移植中心得到应用，并将促进同种异体移植的长期保存。
Kidney transplantation has become a routine procedure in the treatment of patients with kidney failure, and requires collaboration of experts from different disciplines, such as nephrology, surgery, immunology, pathology, infectious disease medicine, cardiology, and oncology. Grafts can be obtained from deceased or living donors, with different logistical requirements and implications for long-term graft patency. 1-year graft survival rates are greater than 95% in many centres but improvement of long-term function remains a challenge. New developments in molecular immunology and computational biology have increased precision of donor and recipient matching of HLA and non-HLA compatibility. Individual omics-wide molecular diagnostics, extracorporeal therapies, and drug developments allow for precise individual decision making and treatment. Tolerance induction by mixed chimerism without toxic conditioning and with a low risk of graft versus host disease is a visionary but realistic goal. Some of these innovations are already used in modern transplant centres and will allow advancement in long-term allograft preservation.