Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Nat Rev Nephrol. 2010 May;6(5):297-306. doi: 10.1038/nrneph.2010.34. Epub 2010 Mar 16.

Sensitized renal transplant recipients: current protocols and future directions.

Author information

  • 1Department of Nephrology and Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA. gloor.james@mayo.edu

Abstract

The identification of suitable donor kidneys for transplant candidates with high levels of circulating antibodies against human leukocyte antigen (HLA) is a major challenge and results in prolonged waiting times for transplantation. Technological advances in antibody characterization have permitted a more comprehensive assessment of anti-HLA antibody activity, as well as providing new insights into the clinical effect of HLA antibody class and specificity. Protocols have been developed that enable successful transplantation in patients with donor-specific antibodies (anti-HLA antibodies reactive against their donors). These protocols provide satisfactory early to intermediate-term allograft survival, and constitute an important advance in transplantation. Nevertheless, acute antibody-mediated rejection (AMR) remains a significant challenge, occurring in 20-50% of antibody-incompatible kidney transplantations. Although therapy directed toward lowering donor-specific antibody activity seems to be successful in reversing acute AMR, this condition still has an important negative impact on allograft survival. In addition, subclinical AMR seems to complicate a substantial proportion of positive-crossmatch transplantations even in the absence of allograft dysfunction, and may result in chronic histological abnormalities and shortened allograft function. New interventions for preventing acute AMR, such as anti-C5 antibody-mediated complement blockade and proteasome inhibitor-mediated plasma cell depletion, are promising therapeutic avenues currently under investigation.

PMID:
20234355
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Nature Publishing Group
    Loading ...
    Write to the Help Desk