Antibody-Mediated Rejection Pathogenesis, Prevention, Treatment, and Outcomes英文文献资料.docVIP

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Antibody-Mediated Rejection Pathogenesis, Prevention, Treatment, and Outcomes英文文献资料.doc

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Antibody-Mediated Rejection Pathogenesis, Prevention, Treatment, and Outcomes英文文献资料

HindawiPublishingCorporation JournalofTransplantation Volume2012,ArticleID201754,7pages doi:10.1155/2012/201754 ResearchArticle Antibody-MediatedRejection: Pathogenesis,Prevention,Treatment,andOutcomes OliviaR.Blume, SarahE.Yost, andBruceKaplan 1 2 3 1 2 3 AbdominalTransplantation,UniversityofArizonaMedicalCenter,Tucson,AZ,USA AbdominalTransplantation,DepartmentofPharmacy,UniversityofArizonaMedicalCenter,Tucson,AZ,USA UniversityofArizonaCollegeofMedicine,1501NorthCampbellAvenue,Tucson,AZ85724,USA CorrespondenceshouldbeaddressedtoOliviaR.Blume,olivia.blume@ Received19October2011;Revised4November2011;Accepted28December2011 AcademicEditor:BanuSis Copyright?2012OliviaR.Blumeetal. This is an open access article distributed under the Creative Commons Attribution License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly cited. Antibody-mediatedrejection(AMR)isamajorcauseoflatekidneytransplantfailure.Itisimportanttohaveanunderstandingof human-leukocyteantigen(HLA)typingincludingwell-designedstudiestodetermineanti-MHC-class-I-relatedchainA(MICA) andantibodyrejectionpathogenesis.Thiscanallowformorespeci?cdiagnosisandtreatmentwhichmayimprovelong-term graftfunction.HLA-speci?cantibodydetectionpriortotransplantationallowsonetohelpdeterminetheriskforAMRwhile detectionofDSAalongwithabiopsycon?rmsit.ItisnowappreciatedthatbiopsyforAMRdoesnothavetoincludedi?useC4d, butdoesrequireacloserlookatperitubularcapillarymicrovasculature.Althoughplasmapheresis(PP)ise?ectiveinremoving alloantibodies(DSAs)fromthecirculation,reboundsynthesisofalloantibodiescanoccur.Splenectomyisusedindesensitization protocolsforABOincompatibletransplantsaswellasbeingfoundtotreatAMRrefractorytoconventionaltreatment.Alsousedare agentstargetedforplasmacells,Bcells,andthecomplementcascadewhicharebortezomibrituximabandeculizumab,respectively. 1.UnderstandingHLA Sensitization prior to transplant can occur by pregnancy or blood tran