臨床泌尿器科69巻13号

2015年12月発行

特集 知っておきたい腎移植の最新情報—基礎から臨床まで Ⅴ．免疫抑制法とTDM

抗体陽性腎移植における免疫抑制法

著者： 齋藤満¹² 佐藤滋³ 山本竜平² 鶴田大² 井上高光² 成田伸太郎² 土谷順彦² 羽渕友則¹²

所属機関： ¹秋田大学医学部附属病院血液浄化療法部 ²秋田大学大学院医学系研究科腎泌尿器科学講座 ³秋田大学医学部附属病院腎疾患先端医療センター

ページ範囲：P.1138 - P.1143

要旨　抗体陽性腎移植は抗体関連型拒絶反応（antibody-mediated rejection：ABMR）のリスクが高い腎移植である。ABMRの発症は移植腎の生着期間に悪影響を及ぼすため，予防のための脱感作が必須であり，抗体除去療法，抗体産生抑制，抗体産生細胞の除去を軸とした免疫抑制プロトコールが用いられる。リツキシマブの登場や免疫グロブリン投与などによってB細胞系をコントロールしやすくなり，以前は禁忌とされた免疫学的にリスクの高い抗体陽性腎移植も克服されつつあるものの，「どこまでの免疫学的リスクが許容されるか」の命題についてはいまだ明らかとなっておらず，大規模な無作為化比較試験の結果が待たれるところである。

参考文献

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