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Transplant Proc. 2012 Jan;44(1):60-1. doi: 10.1016/j.transproceed.2011.12.028.

Desensitizing the broadly human leukocyte antigen-sensitized patient awaiting deceased donor kidney transplantation.

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  • 1Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. sjordan@cshs.org

Abstract

For broadly human leukocyte antigen-sensitized patients (HS; calculated panel-reactive antibody >80%), options for deceased donor (DD) transplantation are extremely limited. Data from United Network for Organ Sharing (2000-2009) indicate that <10% of HS patients are transplanted each year. Immune modulation of HS patients using intravenous immunoglobulin (IVIG) and rituximab has shown promise in reducing donor-specific antibody (DSA) titers and improving the chances for successful transplantation for patients awaiting DD transplants. Critical to the success of desensitization with IVIG + rituximab is a coherent antibody-testing strategy aimed at detection of DSA reductions and identification of crossmatch parameters that are associated with a low likelihood of antibody-mediated rejection posttransplant. Here, we discuss data that examine the efficacy of IVIG + rituximab in reducing DSA levels and improving chances for a successful DD transplantation. Patient and graft survival data are also presented as is an analysis of the safety of IVIG + rituximab in sensitized patients.

Copyright © 2012 Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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