신이식 후 면역반응의 이해 2부 이식면역검사와 면역억제제
Allograft Immune Reaction of Kidney Transplantation Part 2. Immunosuppression and Methods to Assess Alloimmunity
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이식을 위해서는 수여자와 공여자의 혈액형과 HLA type을 알아야 한다. 통상 ABO 혈액형이 적합한 경우 이식할 수 있으며 HLA 부적합은 근래 큰 문제가 되지 않으나 HLA 부적합이 없는 경우 이식장기의 장기생존률이 높다. PRA(panel reactive antibody)는 수여자가 HLA에 감작되었는지 검사하는 방법이며 이식 전에는 반드시 교차반응검사를 하여 음성인 경우에만 이식을 진행한다. 이식 전후에 donor specific antibody(DSA)를 검사하여 이식장기에 대한 수여자의 면역반응을 예측할 수 있다. 근래에는 스테로이드, calcineurin inhibitor(cyclosporine, tacrolimus), azathioprine 또는 mycophenolate mofetil (MMF)의 삼제요법을 주로 사용하며 항림프구 항체 (Thymoglobulin 또는 항IL-2 receptor 항체 basiliximab/daclizumab)을 이용하여 이식 초기에 면역억제상태를 induction하는 경우도 많다.
Abstract
For solid organ transplant, ABO blood type of donor and recipient should be compatible in principle. Recent improvement of immunosuppressant made HLA typing not so important while no-mismatch transplant still shows the longest graft survival. PRA(panel reactive antibody) test is to screen and identify recipients with HLA sensitization. When solid organ transplant is scheduled, cross-match test of donor cell and recipient serum should be performed and positive result of cross-match prohibits transplantation. Donor specific antibody (DSA) test can predict the severity of recipient immune reaction against donor organ. Today's mainstay of allograft immunosuppressant regimen is triple therapy of steroid, calcineurin inhibitor(cyclosporine, tacrolimus), azathioprine or mycophenolate mofetil(MMF). Antibody induction using Thymoglobulin or anti-IL-2 receptor antibody(basiliximab or daclizumab) is frequently practiced as well.
참고문헌 (16)
- Gloor JM, "ABO incompatible kidney transplantation", Curr Opin Nephrol Hypertens, 16, pp.529~534 (2007)
- Salama AD, "Drug insight: rituximab in renal disease and transplantation", Nat Clin Pract Nephrol, 2, pp.221~230 (2006)
- Shishido S, "Current status of ABO-incompatible kidney transplantation in children", Pediatr Transplant, 9, pp.148~154 (2005)
- Takahashi K., "A new concept of accommodation in ABO-incompatible kidney transplantation", Clin Transplant, 19(14), pp.76~85 (2005)
- Warren DS, "Successful renal transplantation across simultaneous ABO incompatible and positive cross-match barriers", Am J Transplant, 4, pp.561~568 (2004)
- Morris PJ, "Analysis of factors that affect outcome of primary cadaveric renal transplantation in the UK. HLA Task Force of the Kidney Advisory Group of the United Kingdom Transplant Support Service Authority (UKTSSA)", Lancet, 354(9185), pp.1147~1152 (1999)
- Sarwal MM, "Continued superior outcomes with modification and lengthened follow-up of a steroid- avoidance pilot with extended daclizumab induction in pediatric renal transplantation", Transplantation, 76, pp.1331~1339 (2003)
- Vidhun JR, "Corticosteroid avoidance in pediatric renal transplantation", Pediatr Nephrol, 20, pp.418~426 (2005)
- Ojo AO, "Mycophenolate mofetil reduces late renal allograft loss independent of acute rejection", Transplantation, 69(11), pp.2405~2409 (2000)
- Bakker RC, "Early interstitial accumulation of collagen type I discriminates chronic rejection from chronic cyclosporine nephrotoxicity", J Am Soc Nephrol, 14, pp.2142~2149 (2003)
- Pearson TCM, "Efficacy and Safety of Mycophenolate Mofetil(MMF)", Sirolimus(SRL) Maintenance Therapy after Calcineurin Inhibitor(CNI) Withdrawal in Renal Transplant Recipients: Final Results of the Spare-the-Nephron(STN) Trial. In: American Transplant Congress 2008. Toronto, Ontario, Canda: Wiley; 2008. p. 213, 2008
- Swanson SJ, "Kidney transplantation with rabbit antithymocyte globulin induction and sirolimus monotherapy", Lancet, 360(9346), pp.1662~1664 (2002)
- Nydegger U, "ABO histo- blood group system-incompatible allografting", Int Immunopharmacol, 5, pp.1147~153 (2005)
- Becker YT, "The emerging role of rituximab in organ transplantation", Transpl Int, 19, pp.621~628 (2006)
- Jordan SC, "Presensitization: the problem and its management", Clin J Am Soc Nephrol, 1, pp.421~432 (2006)
- Jordan SC, "Current approaches to treatment of antibody-mediated rejection", Pediatr Transplant, 9, pp.408~415 (2005)