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Curr Opin Organ Transplant. 2012 Aug;17(4):386-92. doi: 10.1097/MOT.0b013e328356132b.

HLA incompatible renal transplantation.

Author information

1
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. rmonty@jhmi.edu

Abstract

PURPOSE OF REVIEW:

Human leukocyte antigen (HLA) sensitization is a major public health problem that limits access to renal transplantation for 30% of the patients awaiting a kidney transplant. This review describes the transplantation modalities available to the sensitized patient and discusses aspects of the donor/recipient phenotypes that determine the most suitable option for a particular patient.

RECENT FINDINGS:

Patients, who undergo desensitization have a significant survival benefit compared with similar patients, who either remain on dialysis or wait for a compatible donor. The initial donor-specific antibody (DSA) strength is the best predictor of outcome and cost of desensitization. In small, uncontrolled single center trials, complement inhibitors, proteasome inhibitors and anti-CD20 have been used to both prevent and reverse antibody-mediated rejection (AMR).

SUMMARY:

With new agents being introduced into the armamentarium, which have not undergone rigorous investigation, it is important to emphasize that plasmapheresis, intravenous immunoglobulin, increased sharing, and kidney-paired donation are very effective strategies for transplanting sensitized patients. However, a significant population of patients will not benefit from either kidney-paired donation or desensitization and will require a hybrid technique in which the goal of matching is to reduce the strength of the DSA to facilitate desensitization.

PMID:
22790073
DOI:
10.1097/MOT.0b013e328356132b
[Indexed for MEDLINE]
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