该综述讲述血小板的基础功能对于器官移植物排斥反应的特殊影响。移植前的供受者体内就可以发生血小板的活化；其同样可以发生在抗体和细胞介导的排斥反应中。在器官切取时进行的活检证实活化的血小板附着于血管内皮细胞或者粒细胞的表面。此外，许多等待移植的患者其导致器官衰竭的疾病可能产生了体内活化的血小板，但也可能是移植前后相关的支持治疗干预产生的。血小板在同种异体移植和异种移植超急性排斥反应中的作用是受到广泛认同的。血管内血小板的聚集同样是移植实验以及临床移植急性抗体或者细胞介导的排斥反应中的主要部分。在急性排斥反应中，血小板能够分泌趋化因子导致单核细胞的聚集。其后单核细胞、巨噬细胞和T细胞通过供受体的配对（包括P-选择素/PSGL-1和CD40/CD14）进行相互作用。这些机制的明确对抑制血小板介导的免疫刺激提供潜在的治疗方法，但是在围手术期需要保持正常的凝血能力限制了其应用。

Kirk AD, Morrell CN, Baldwin Iii WM.
Emory Transplant Center, Department of Surgery, Emory University, Atlanta, GA.

This review relates the basic functions of platelets to specific aspects of organ allograft rejection. Platelet activation can occur in the donor or recipient before transplantation as well as during antibody- and cell-mediated rejection. Biopsies taken during organ procurement from cadaver donors have documented that activated platelets are attached to vascular endothelial cells or leukocytes. In addition, many patients waiting for transplants have activated platelets due to the diseases that lead to organ failure or as a result of interventions used to support patients before and during transplantation. The contribution of platelets to hyperacute rejection of both allografts and xenografts is well recognized. Intravascular aggregates of platelets can also be prominent in experimental and clinical transplants that undergo acute antibody or cell-mediated rejection. In acute rejection, platelets can recruit mononuclear cells by secretion of chemokines. After contact, monocytes, macrophages and T cells interact with platelets through receptor/ligand pairs, including P-selectin/PSGL-1 and CD40/CD154. There is a potential for therapy to inhibit platelet mediated immune stimulation, but it is counterbalanced by the need to maintain coagulation in the perioperative period.