ABO-incompatible heart transplantation.
ABO-incompatible heart transplantation.
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DOI：
10.1097/mop.0000000000000398
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发表时间：
2016-10
影响因子：
3.6
通讯作者：
West LJ
中科院分区：
文献类型：
--
作者：
Urschel S;West LJ
ABO血型不合(ABOI)幼儿心脏移植(HTX)在许多国家已经从一种实验方法演变为一种标准的分配方案。ABOI移植的临床和免疫学研究揭示了不成熟的免疫系统及其在儿童时期优越的移植物接受性和抗原特异性耐受中的作用。多中心经验证实，ABO相容(ABOc)HTX与ABO相容HTX相比，具有同等的精算存活率、无排斥反应和移植物血管病变。在长期随访中，观察到针对捐献者血型的抗体产生和B细胞免疫减少的观察得到证实。在这种情况下，导致耐受性的机制包括B细胞和补体系统之间的相互作用以及B细胞记忆的发展。ABH多糖类抗原的更好的特性改进了血型抗体的诊断方法和临床评估。已经探索了年龄、免疫成熟度和治疗干预措施的界限，以扩大ABOI HTX的适用性，并产生了可能对婴儿和ABOI其他器官移植以外的HTX患者有用的数据。ABH抗原的耐受性可能延伸至人类白细胞抗原反应。这篇综述对ABOI HTX的临床演变和相关的免疫学发现提供了洞察力。讨论了当前的经验和界限，以及近期和潜在的未来发展，以供其他患者和年龄组使用。
ABO-incompatible (ABOi) heart transplantation (HTx) in young children has evolved from an experimental approach to a standard allocation option in many countries. Clinical and immunological research in ABOi transplantation has revealed insight into the immature immune system and its role in superior graft acceptance in childhood and antigen-specific tolerance. Multicenter experience has confirmed equal actuarial survival, freedom from rejection and graft vasculopathy comparing ABOi to ABO-compatible (ABOc) HTx. Observations of reduced antibody production and B-cell immunity towards the donor blood group have been confirmed in long-term follow-up. Mechanisms contributing to tolerance in this setting involve the interplay between B-cells and the complement system and the development of B-cell memory. Better characterization of the ABH polysaccharide antigens has improved diagnostic methods and clinical assessment of blood group antibodies. Boundaries regarding age, immune maturity and therapeutic interventions to extend the applicability of ABOi HTx have been explored and resulted in data that may be useful for HTx patients beyond infancy and ABOi transplantation of other organs. Tolerance of ABH antigens possibly extends to HLA response. This review provides insight into the clinical evolution of ABOi HTx and associated immunologic discoveries. Current experiences and boundaries are discussed together with recent and potential future developments for utilization in other patient and age groups.