腎移植の最近の進歩と臨床成績

Recent Advances and Clinical Outcomes of Kidney Transplantation.

• Charat Thongprayoon
• Panupong Hansrivijit
• Napat Leeaphorn
• Prakrati Acharya
• Aldo Torres-Ortiz
• Wisit Kaewput
• Karthik Kovvuru
• Swetha R Kanduri
• Tarun Bathini
• Wisit Cheungpasitporn

抄録

最近の手術、免疫抑制、モニタリングのプロトコルの進歩により、1年間の腎移植成績が大幅に改善された。それにもかかわらず、長期的な腎移植の転帰には大きな変化はありませんでした。実際、腎移植後の慢性および急性の抗体介在性拒絶反応（ABMR）および非免疫学的合併症（原発性腎疾患の多発、心血管疾患、感染症、悪性腫瘍などの合併症を含む）は、腎移植の失敗の主な要因となっている。組織学的診断と非侵襲的サーベイランスを強化するための分子技術の使用は、臨床腎移植の分野での最新の研究が主に焦点を当てているように思われます。臨界感作の克服、抗ヒト白血球抗原（HLA）抗体の発現抑制、慢性活動性ABMRの治療、腎移植後の非免疫学的合併症（原発性腎疾患の再発や心血管疾患、感染症、悪性腫瘍などの合併症）の軽減などを目的とした免疫抑制法の発見に、ますます革新的なアプローチが用いられています。電子カルテ（EHR）の活用が進む現在、近い将来、ビッグデータと人工知能が腎移植研究の形を変えていくと強く信じられています。また、遠隔医療の利用が増えており、遠隔地の腎移植患者に手を差し伸べたり、希少な医療資源を腎移植のために利用しやすくするなどのメリットがあります。この記事では、患者の生存率だけでなく、長期的な全移植片に影響を与える可能性のある腎移植の最新の研究開発についても触れています。また、生きた腎臓提供の最新動向についても探っている。

Recent advances in surgical, immunosuppressive and monitoring protocols have led to the significant improvement of overall one-year kidney allograft outcomes. Nonetheless, there has not been a significant change in long-term kidney allograft outcomes. In fact, chronic and acute antibody-mediated rejection (ABMR) and non-immunological complications following kidney transplantation, including multiple incidences of primary kidney disease, as well as complications such as cardiovascular diseases, infections, and malignancy are the major factors that have contributed to the failure of kidney allografts. The use of molecular techniques to enhance histological diagnostics and noninvasive surveillance are what the latest studies in the field of clinical kidney transplant seem to mainly focus upon. Increasingly innovative approaches are being used to discover immunosuppressive methods to overcome critical sensitization, prevent the development of anti-human leukocyte antigen (HLA) antibodies, treat chronic active ABMR, and reduce non-immunological complications following kidney transplantation, such as the recurrence of primary kidney disease and other complications, such as cardiovascular diseases, infections, and malignancy. In the present era of utilizing electronic health records (EHRs), it is strongly believed that big data and artificial intelligence will reshape the research done on kidney transplantation in the near future. In addition, the utilization of telemedicine is increasing, providing benefits such as reaching out to kidney transplant patients in remote areas and helping to make scarce healthcare resources more accessible for kidney transplantation. In this article, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.