腎移植におけるドナー特異的抗HLA抗体

抄録

Advances in immunosuppressants, such as rituximab, basiliximab, and others, enable organ transplantation for sensitized patients. In fact, an adequate desensitization protocol would lead to acceptable outcomes in the acute phase. However, it is true that the management of acute or, in particular, chronic antibody-mediated rejection resulting from donor-specific antihuman leukocyte antigens (HLA) antibodies, is still an important issue to improve better long-term graft survival. Thus DSAs seem to be a central research topic in the field of organ transplantation. In the 1960s, the introduction of azathioprine brought the beginning of contemporary renal transplantation. Following this, the barrier of anti-AB antigens and anti-HLA antibodies was recognized: incompatibilities were considered as a high risk factor for renal transplantation. In the next half-century, the main attention was paid to T cell-mediated rejection. This led to the development of calcineurin inhibitors and several antibody drugs: a depletion of lymphocytes that enabled the control of T cell-mediated rejection. DSAs have finally received much attention in the 21^st century because controlling them brings better outcomes in renal transplantations. This manuscript refers to examination, diagnoses, management, treatment, and outcomes in DSA-positive renal transplantation.