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摘要: 抗体介导的排斥反应(AMR)是慢性移植肾失功的重要原因，而供体特异性抗体(DSA)是引起同种移植排斥反应的重要因素。DSA包括移植前预存DSA和移植后新生DSA(dnDSA)。预存DSA与移植后的超急性排斥反应密切相关，它对肾移植结果的影响与DSA的类型和强度有关；而dnDSA预示着AMR的开始，在慢性排斥反应中起着重要作用，影响移植肾功能和明显降低移植物的存活率。DSA介导的免疫损伤主要与损伤血管内皮细胞相关。目前对于DSA相关AMR的预防和治疗策略主要有：(1)通过血浆置换清除抗体；(2)通过联合应用CD20抗体(利妥昔单抗)+他克莫司+吗替麦考酚酯，或单用蛋白酶体抑制剂硼替佐米来抑制B细胞，减少抗体的产生；(3)利用补体C5单克隆抗体依库珠单抗阻断补体活化；(4)静脉注射免疫球蛋白；(5)脾脏切除。通过DSA监测来预防AMR具有重要临床意义。
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