实体器官移植中的内皮功能障碍

Endothelial dysfunction in solid organ transplantation

摘要

器官移植是挽救终末期器官衰竭的重要手段，然而移植器官在获取、保存及血运重建过程中常面临缺血-再灌注损伤及排斥反应等多种病理打击，严重影响移植物的存活和功能。内皮功能障碍是影响移植物功能及移植预后的核心环节。缺血-再灌注损伤、排斥反应、使用免疫抑制药和巨细胞病毒感染等因素以各种急性或慢性方式驱动内皮紊乱。急性期内皮损伤参与移植物功能延迟恢复与急性排斥反应，慢性期则表现为移植物血管病变，最终导致移植物失功。本文就器官移植中导致内皮损伤的关键病理生理机制、临床后果及防治策略进行综述，以期为改善内皮功能与移植预后提供参考。

Abstract

Organ transplantation is a crucial approach for saving patients with end-stage organ failure. However, transplant organs are frequently subjected to various pathological insults, such as ischemia-reperfusion injury and rejection during the processes of procurement, preservation and revascularization, which severely compromise graft survival and function. Endothelial dysfunction represents a core determinant of graft function and transplant outcomes. Factors including ischemia-reperfusion injury, rejection, immunosuppressive drug use and cytomegalovirus infection drive endothelial dysregulation through diverse acute or chronic mechanisms. In the acute phase, endothelial injury contributes to delayed graft function and acute rejection, while in the chronic phase, it manifests as graft vasculopathy, ultimately leading to graft failure. This review summarizes the key pathophysiological mechanisms underlying endothelial injury in organ transplantation, its clinical consequences and preventive and therapeutic strategies, aiming to provide insights for improving endothelial function and transplant outcomes.

关键词

器官移植 / 内皮细胞 / 内皮功能障碍 / 移植物血管病变 / 缺血-再灌注损伤 / 排斥反应 / 炎症反应 / 免疫抑制

Key words

Organ transplantation / Endothelial cell / Endothelial dysfunction / Graft vasculopathy / Ischemia-reperfusion injury / Rejection / Inflammation / Immunosuppression

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基金资助

国家自然科学基金(82271805)

国家自然科学基金(82270783)