PMID- 15280676
OWN - NLM
STAT- MEDLINE
DCOM- 20040818
LR  - 20220309
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 78
IP  - 2
DP  - 2004 Jul 27
TI  - The acceptable mismatch program as a fast tool for highly sensitized patients 
      awaiting a cadaveric kidney transplantation: short waiting time and excellent 
      graft outcome.
PG  - 190-3
AB  - There are many highly sensitized patients on the kidney waiting lists of organ 
      exchange organizations because it is difficult to find a crossmatch negative 
      cadaver kidney for these patients. Recently, several protocols have been 
      developed to remove the donor-specific human leukocyte antigen (HLA) antibodies 
      from the serum of these patients before transplantation. These approaches, 
      including the use of intravenous immunoglobulins, plasmapheresis and 
      immunoglobulins (plasmapheresis-cytomegalovirus-immunoglobulin), and 
      immunoabsorption, seem to lead to a certain success rate, although the additional 
      immunosuppression necessary to remove and control the production of 
      donor-specific alloantibodies may have its impact on the short-term (infections) 
      and long-term (incidence of cancer) immune surveillance. Furthermore, some of 
      these therapies represent a considerable financial burden for patients and 
      society. In the present report, we advocate selection of crossmatch negative 
      donors on the basis of the Acceptable Mismatch Program, as the first and best 
      option for highly sensitized patients to undergo transplantations. No additional 
      immunosuppression is necessary, and graft survival in this group of "difficult" 
      patients is identical to that of nonsensitized recipients. Because the nature of 
      the HLA polymorphism does not allow all patients to profit from this approach, 
      removal of circulating HLA antibodies can be considered as a rescue therapy for 
      those patients for whom the Acceptable Mismatch Program does not give a solution.
FAU - Claas, Frans H J
AU  - Claas FH
AD  - Department of Immunohematology and Blood Transfusion, Section Immunogenetics and 
      Transplantation Immunology, Leiden University Medical Center, Albinusdreef 2, 
      2333 ZA Leiden, The Netherlands.
FAU - Witvliet, Marian D
AU  - Witvliet MD
FAU - Duquesnoy, Rene J
AU  - Duquesnoy RJ
FAU - Persijn, Guido G
AU  - Persijn GG
FAU - Doxiadis, Ilias I N
AU  - Doxiadis II
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Cadaver
MH  - Graft Survival/*immunology
MH  - HLA-A Antigens/immunology
MH  - HLA-B Antigens/immunology
MH  - HLA-DR Antigens/immunology
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - Immunization
MH  - Kidney Transplantation/*immunology
MH  - Time Factors
MH  - Tissue Donors
MH  - Treatment Outcome
MH  - Waiting Lists
EDAT- 2004/07/29 05:00
MHDA- 2004/08/19 05:00
CRDT- 2004/07/29 05:00
PHST- 2004/07/29 05:00 [pubmed]
PHST- 2004/08/19 05:00 [medline]
PHST- 2004/07/29 05:00 [entrez]
AID - 00007890-200407270-00005 [pii]
AID - 10.1097/01.tp.0000129260.86766.67 [doi]
PST - ppublish
SO  - Transplantation. 2004 Jul 27;78(2):190-3. doi: 10.1097/01.tp.0000129260.86766.67.