在HLA不相容的移植中进行分子诊断
Miray Guney1, Petra Hruba2, Ondrej Viklicky3
1Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic.
Transplantation reviews (Orlando, Fla.)
|February 25, 2026
概括
人类白细胞抗原不兼容的脏移植面临抗体介导的排斥. 像转录学和无细胞DNA这样的先进诊断方法在这些高风险患者的早期检测和拒绝管理方面表现有前途.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 免疫学 免疫学 免疫学
- 移植科学 移植科学
背景情况:
- 人类白细胞抗原不兼容 (HLA-i) 脏移植对于高度敏感的患者至关重要,但由于早期的捐赠者特异性抗体 (DSA) 反弹和非免疫损伤,其抗体中介排斥 (AMR) 率很高.
- 传统的代移植活检和组织学可能无法在敏感受体中检测到早期或亚临床AMR.
- 目前的脱敏和诱导协议,包括imlifidase,不能完全防止AMR.
研究的目的:
- 评估在HLA-i移植中早期检测AMR的先进诊断方法.
- 探索转录学和非侵入性生物标志物的实用性,以监测排斥.
- 强调多式联通方式的方法,及时干预和预防慢性损伤.
主要方法:
- 利用基于组织的转录学,特别是分子显微镜诊断系统 (MMDx) 和班夫人类器官移植基因组 (B-HOT).
- 评估了血捐赠者衍生的无细胞DNA (dd-cfDNA) 作为一种非侵入性生物标志物.
- 综合组织学,DSA监测,转录学和生物标志物用于AMR表型化.
主要成果:
- 转录组学 (MMDx,B-HOT) 为检测形态变化之前的分子AMR表型提供了增强的灵敏度.
- 血dd-cfDNA与分子排斥活性相关,有助于高风险患者的纵向监测.
- 通过多模式诊断,可以早期发现亚临床损伤.
结论:
- 先进的转录基因分析和非侵入性生物标志物改善了HLA-i移植中的AMR早期检测.
- 多种模式的诊断方法对于及时干预和预防慢性移植球病至关重要.
- 这些方法在敏感的接受者中特别有价值,以有效管理AMR.
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