心移植における抗ドナー抗体と抗体関連型拒絶反応について

抄録

Early diagnosis and early treatment are important for the antibody-mediated rejection (AMR) to account for 10%-20% of the rejection after heart transplantation because of poor prognosis and the onset extension risk of the cardiac allograft vasculopathy (CAV).
More than 90% of patients have been waitng for heart transplantations with a ventricular assist device for approximately 1,000 days in our country, and anti-HLA antidodies, which cause AMR extension to the next CAV after the transplant, have been paid attention to.
The development of the test to detect advances for anti-HLA antibodies in recent years, and there are CDC-XM (complement-dependency-related cytotoxic tests), AHG-XM, FCXM (flowcyte cross-match), Solid-phase Assay (ELISA, FCM, Luminex), make it necessary to know that each characteristic by a target specific antibody, the sensitivity, of the effect of the drug in each to be different.
It is recommended that the examination for AMR by the measurement of anti-HLA antibodies and C4d-immunostaining in the posttransplant myocardial biopsy in two and four weeks, and subsequently in 3, 6, 12 months posttransplant, and when clinical AMR is suspected. About AMR caused by the non-HLA antibodies, we soon expect the development of a non-HLA antibody method for measurement.
As for the AMR treatment, plasmapheresis, a large amount of intravenous immunoglobulin (IVIG), anti-CD20 monoclonal antibody (rituximab), use of corticosteroid and/or cyclophosphamide, and switching from cyclosporine to tacrolimus for the immunosuppressive therapy are considered.