Humoral rejection of human organ transplants

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• 作者：Paul J. Michaels ; Michael C. Fishbein and Robert B. Colvin
• 刊名：Springer Seminars in Immunopathology
• 出版年：2003
• 出版时间：September 2003
• 年：2003
• 卷：25
• 期：2
• 页码：119-140
• 全文大小：377 KB
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Biomedicine
  Immunology
  Internal Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1863-2300

文摘

Although T-cell mediated rejection has remained the mostcommon form of acute rejection, humoral rejection now accountsfor a substantial fraction in patients with kidney or heartallografts, and probably causes the majority of acute graftlosses. The frequency, variously estimated at 20–30%, isattributed to improved methods of detection, including stainingfor C4d in tissues, which is more sensitive and specific thanhistological features. Detection of circulating anti-donorreactive antibody (usually to donor HLA antigens) confirms thediagnosis. The clinico-pathological entity of acute humoralrejection is well accepted in kidney and increasingly in hearttransplantation. Recent evidence points to a new category ofchronic humoral rejection, which accounts for about 60% ofchronic rejection of kidneys. Importantly, the hallmark ofhumoral rejection, C4d, can be detected in the grafts beforedevelopment of histological evidence of chronic rejection.Humoral rejection is generally not responsive to the usualanti-T cell immunosuppressive agents, but small, non-controlledtrials suggest humoral rejection can be reversed withplasmapheresis, intravenous immunoglobulin, anti-CD20 and othertreatments, all of which deserve formal clinical evaluation.Prophylaxis for chronic rejection is expected to requiredonor-specific serological monitoring and protocolbiopsies.