HLA incompatible renal transplantation

Robert A. Montgomery, Daniel Warren, Dorry Segev, Andrea A. Zachary

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)386-392
Number of pages7
JournalCurrent Opinion in Organ Transplantation
Volume17
Issue number4
DOIs
Publication statusPublished - Aug 2012
Externally publishedYes

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Keywords

  • complement inhibition
  • desensitization
  • donor-specific antibodies
  • human leukocyte antigens incompatible transplantation
  • kidney-paired donation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation

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