肾移植是终末期肾病患者的挽救生命的治疗方法。然而，移植排斥的挑战以及与免疫抑制剂相关的并发症需要更深入地了解潜在的免疫机制。 T 细胞耗竭是一种以效应器功能受损和抑制性受体持续表达为特征的状态，在肾移植中发挥双重作用。虽然适度的 T 细胞耗竭可以通过调节同种异体反应性 T 细胞反应来帮助移植物接受，但过度耗竭可能会损害受体控制病毒感染和肿瘤的能力，从而带来重大的健康风险。此外，针对T细胞耗竭以促进移植物耐受的药物以及使用免疫检查点抑制剂治疗移植受者的癌症都是值得进一步关注和研究的领域。本综述旨在全面了解肾移植后 T 细胞耗竭水平的变化及其对移植物存活和患者预后的影响。我们讨论了 T 细胞耗竭的分子机制、特定耗竭标志物的作用、免疫抑制疗法的潜在影响以及对 T 细胞耗竭水平的药物干预。此外，我们证明了有利地调节 T 细胞耗竭、提高移植物存活的潜力。未来的研究应重点关注不同免疫状态和亚群中 T 细胞耗竭的区别，以及耗竭的 T 细胞与其他免疫细胞之间的相互作用。了解这些动态对于优化移植结果并确保移植物长期存活并同时保持免疫能力至关重要。版权所有 © 2024 Wang、Zhang、Zhong 和 Wei。

Renal transplantation is a life-saving treatment for patients with end-stage renal disease. However, the challenge of transplant rejection and the complications associated with immunosuppressants necessitates a deeper understanding of the underlying immune mechanisms. T cell exhaustion, a state characterized by impaired effector functions and sustained expression of inhibitory receptors, plays a dual role in renal transplantation. While moderate T cell exhaustion can aid in graft acceptance by regulating alloreactive T cell responses, excessive exhaustion may impair the recipient's ability to control viral infections and tumors, posing significant health risks. Moreover, drugs targeting T cell exhaustion to promote graft tolerance and using immune checkpoint inhibitors for cancer treatment in transplant recipients are areas deserving of further attention and research. This review aims to provide a comprehensive understanding of the changes in T cell exhaustion levels after renal transplantation and their implications for graft survival and patient outcomes. We discuss the molecular mechanisms underlying T cell exhaustion, the role of specific exhaustion markers, the potential impact of immunosuppressive therapies, and the pharmaceutical intervention on T cell exhaustion levels. Additionally, we demonstrate the potential to modulate T cell exhaustion favorably, enhancing graft survival. Future research should focus on the distinctions of T cell exhaustion across different immune states and subsets, as well as the interactions between exhausted T cells and other immune cells. Understanding these dynamics is crucial for optimizing transplant outcomes and ensuring long-term graft survival while maintaining immune competence.Copyright © 2024 Wang, Zhang, Zhong and Wei.