Solid organ transplantation is a life-saving procedure for patients with end-stage organ disease. Over the past 70 years, tremendous progress has been made in solid organ transplantation, particularly in T-cell-targeted immunosuppression and organ allocation systems. However, humoral alloimmune responses remain a major challenge to progress. Patients with preexisting antibodies to human leukocyte antigen (HLA) are at significant disadvantages in regard to receiving a well-matched organ, moreover, those who develop anti-HLA antibodies after transplantation face a significant foreshortening of renal allograft survival. Historical therapies to desensitize patients prior to transplantation or to treat posttransplant AMR have had limited effectiveness, likely because they do not significantly reduce antibody levels, as plasma cells, the source of antibody production, remain largely unaffected. Herein, we will discuss the significance of plasma cells in transplantation, aspects of their biology as potential therapeutic targets, clinical challenges in developing strategies to target plasma cells in transplantation, and lastly, novel approaches that have potential to advance the field.

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浆细胞生物学：移植靶向治疗发展的基础

实体器官移植是终末期器官疾病患者的救命手术。在过去的 70 年里，实体器官移植取得了巨大进展，特别是在 T 细胞靶向免疫抑制和器官分配系统方面。然而，体液同种免疫反应仍然是取得进展的主要挑战。具有预先存在的人类白细胞抗原 (HLA) 抗体的患者在接受匹配良好的器官方面处于显着劣势，此外，移植后产生抗 HLA 抗体的患者面临着肾脏同种异体移植物存活率的显着缩短。在移植前使患者脱敏或治疗移植后 AMR 的历史疗法效果有限，可能是因为它们不会显着降低抗体水平，如浆细胞、抗体产生的来源基本上不受影响。在这里，我们将讨论浆细胞在移植中的重要性、它们作为潜在治疗靶点的生物学方面、开发靶向移植浆细胞的策略的临床挑战，以及有可能推动该领域发展的新方法。