Transplantation Immunology

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12 ????

• Transplantation Immunology

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E Donnall Thomas 1920 -- Joseph Murray
1919-- Nobel Prize in 1990
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Transplantation(??)
????????????????????????????????????? ??(donor)?
????(graft,transpant)??? ??(recipient)???????
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12-1 ????????????

• ?????????????????(??????,allotransplantation)?????
  ??
• ?????????????????????????????????????,?????????(??
  ??)?
• ??????????????,?????????????
• ?????(autograft)?????100??????????(??????????????
  ?)?????????????

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• ????????????
• ???????(MHC)??????,???????????(?????????)????????
  
• ??MHC?????????????????????????

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12-2 ???????????
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??????? (Hyperacute rejection)
??????????????,???????,???????????????????????????
?????????????????????????,???????????,????????????
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??????????
????????7???,???T????,???????????????????????? ??1
-5?????T???????????,????????????????????????????(?
???????),??????????????HLA?
???????????????????????HLA????????HLA?????????????
???????????????,????????? ?
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????????????
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??????
?????????????????????????????????,????????? ??????
?????????????????,????????????????????????????????
???????????????????????? ??????????
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??????
????????(Host against graft reactin,HVGR)
??T??????MHC??????,??????????????? ????????(Graft
against host reactin,GVHR)
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????????
(Graft-versus-host reaction,GVHR)
????????????????,?????????????,???????????????????
???(???HLA??)??????,??????????????????? ?????????
?,?????????????? GVHD????????,??????????1-2???,??
???2-3???????GVHD?????????????????,??????? ??????
????(methotrexate)????????????????GVHD?
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????(microchimerism)???(Starzl) ??????????????????
??????????????????????????????????????????????????
??????,?????,???????????????????? ?????????,?????
???????GVH?HVG????,???????????????????,???????????
????????????????
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????(Transplantation antigen)
??????????????,???? ABO???? -- ???
HLA??(A?B?C,DR?DP?DQ)-- ?? ????????? -- ???
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12-3 MHC???????
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????????
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TCR?????MHC???????
??T??
CTL
CTL
????
Th
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TCR?????MHC???????
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??????????? ????? 1 ??????(familial
grafting)??HLA????? 2 ????(tissue
typing)????????????????????HLA
???????,?????HLA??????????????,HLA-DR??????,HLA-B?
A?????????????DC,??????????,????????,?HLA??????? 3
????(cross-matching)???????????????????????????
??????????????????
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????????? 1 ??????????? 2 ????????????????????
???????? ????????? ?????????A(cyclosporin
A,CsA)?????(cyclophosphamide,CP)?FK506????????????
?? ????ALG?ATG??CD3??CD4??CD8??TCR?? ???????
?
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12-4 ????
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??????????????(HAR) HAR??????????,??????????(nat
ural antibody)????? ????????????????????(xenoanti
gen),???????????????????? a-1,3-????
(Gala-1,3Gal)? ??????????????????,???????????????
?????????????
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• ?? HAR ?????
• ?????????????????????,?Gala-1,3Gal????????????????
  ???,???????????
• ?????? Gala-1,3Gal ????????????????????
• ?????????????????
• ???a-1,3???????????

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???????????????(homologous restriction),??????????
??????????????????????? ???????????(CD46?CD55?CD5
9?)?????????????????????????????????????,????HAR??
??
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????????? (Delyed xeno-transplantation
rejection,DXR) ???????????,????????????? ?????????
NK??????????????????? ???????? ??MHC??????????T??
?????????,???????????
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????????
???CD46?CD55?CD59? ??a-1,3?????????
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