Transplanting the highly sensitized patient: Trials and tribulations

Hariharan S. Iyer, Annette M. Jackson, Andrea A. Zachary, Robert A. Montgomery

Research output: Contribution to journalReview articlepeer-review

Abstract

PURPOSE OF REVIEW: Humoral sensitization to antigens of the human leukocyte antigen and ABO systems remains one of the largest barriers to further expansion in renal transplantation. This barrier translates into prolonged waiting time and a greater likelihood of death. The number of highly sensitized patients on the renal transplant waiting list continues to increase. This review focuses on the options available to these patients and speculates on future directions for incompatible transplantation. RECENT FINDINGS: Desensitization protocols (to remove antibodies), kidney-paired donation (to circumvent antibodies) or a hybrid technique involving a combination of both have broadened the access to transplantation for patients disadvantaged by immunologic barriers. However, the risk of antibody-mediated rejection may be increased and warrants caution. Technical advances in antibody characterization using sensitive bead immunoassays and the C1q assay and therapeutic modalities such as complement inhibitors and proteasome inhibitors have been used to avoid or confront these antibody incompatibilities. SUMMARY: A growing body of knowledge and literature indicates that these diagnostic and therapeutic modalities can facilitate a safer and more successful treatment course for these difficult-to-treat patients. Rigorous investigations into newer interventions will help in broadening the options for these patients and also expand the living donor pool.

Original languageEnglish (US)
Pages (from-to)681-688
Number of pages8
JournalCurrent opinion in nephrology and hypertension
Volume22
Issue number6
DOIs
StatePublished - Nov 2013

Keywords

  • complement inhibition
  • desensitization
  • donor-specific antibodies
  • kidney-paired donation

ASJC Scopus subject areas

  • Internal Medicine
  • Nephrology

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