CAJ | 학술논문

器官移植后长期使用免疫抑制剂具有一系列毒副作用,影响患者和移植物的长期存活.对于患者和器官移植医生而言,诱导免疫耐受是最终极的研究目标.然而,目前对此临床尚缺少有效的实验方案、合适的免疫检测手段,对于完全停药面临的一些伦理和安全问题亦缺乏成熟的建议,因此器官移植”可控耐受”在临床上很难实现.尽管面临种种困难,目前仍然有一些中心谨慎构建了以长期存活为目标的诱导器官移植免疫耐受的处理方案,并取得部分成功.本文对目前临床成功诱导器官移植免疫耐受的方案进行简要综述,包括主动逐渐停药诱导移植免疫耐受,通过混合嵌合诱导器官移植免疫耐受以及调节性T细胞在临床免疫耐受中的应用.
기관이식후장기사용면역억제제구유일계렬독부작용,영향환자화이식물적장기존활.대우환자화기관이식의생이언,유도면역내수시최종겁적연구목표.연이,목전대차림상상결소유효적실험방안、합괄적면역검측수단,대우완전정약면림적일사윤리화안전문제역결핍성숙적건의,인차기관이식”가공내수”재림상상흔난실현.진관면림충충곤난,목전잉연유일사중심근신구건료이장기존활위목표적유도기관이식면역내수적처리방안,병취득부분성공.본문대목전림상성공유도기관이식면역내수적방안진행간요종술,포괄주동축점정약유도이식면역내수,통과혼합감합유도기관이식면역내수이급조절성T세포재림상면역내수중적응용.
The long-term use of immunosuppressive agents after organ transplantation is associated with many undesirable side effects which may limit the survival of patients and transplanted organs.To patients and transplant surgeons,organ transplantation tolerance is the ultimate goal to improve patient's quality of life.The clinical state of allograft acceptance termed "operational tolerance" has remained infrequent in clinical transplantation because of the lack of validated assays or biomarkers predictive of tolerance and the concerns about the safety and ethics of complete withdrawal of immunosuppression.Despite these barriers,a number of investigators have continued to conduct well-designed studies with the long-term goal of inducing clinical transplantation tolerance.This review provides an overviewof the currently successful approaches to achieve clinical operational tolerance,including using immunosuppression slow withdrawal in organ transplantation,transplantation tolerance through mixed chimerism and clinical application of T regulatory cells in tolerance.