What have we learned about how to prevent and treat antibody-mediated rejection in kidney transplantation?
What have we learned about how to prevent and treat antibody-mediated rejection in kidney transplantation?
复制标题
DOI：
10.1111/ajt.15859
复制
发表时间：
2020-06-01
影响因子：
8.8
通讯作者：
Nickerson, Peter W.
中科院分区：
文献类型：
--
作者：
Nickerson, Peter W.
肾移植中抗体介导的排斥反应（ABMR）是晚期移植物丢失的主要原因，尽管迄今为止做出了所有努力，但“标准治疗”仍然是血浆置换、IVIg和类固醇，其本身基于低质量的证据。本文综述了导致记忆和新生供体特异性抗体（DSA）相关ABMR的危险因素，ABMR的最佳预防策略，以及ABMR的预防和新兴治疗方法的进展。由于新药需要通过III期随机对照试验（RCT）获得监管部门的批准，因此提供了ABMR创新试验设计进展的概述。最后，基于在ABMR生物学中获得的见解，确定了未来研究的当前知识差距，这可能会显着影响我们对如何最佳治疗ABMR的理解。
Antibody-mediated rejection (ABMR) in kidney transplantation is a major cause of late graft loss, and despite all efforts to date the "standard of care" remains plasmapheresis, IVIg, and steroids, which itself is based on low quality evidence. This review focuses on the risk factors leading to memory and de novo donor-specific antibody (DSA)-associated ABMR, the optimal prevention strategies for ABMR, and advances in adjunctive and emerging therapies for ABMR. Because new agents require regulatory approval via a Phase 3 randomized control trial (RCT), an overview of progress in innovative trial design for ABMR is provided. Finally, based on the insights gained in the biology of ABMR, current knowledge gaps are identified for future research that could significantly affect our understanding of how to optimally treat ABMR.