PMID- 16398709
OWN - NLM
STAT- MEDLINE
DCOM- 20060316
LR  - 20060109
IS  - 0894-0959 (Print)
IS  - 0894-0959 (Linking)
VI  - 18
IP  - 6
DP  - 2005 Nov-Dec
TI  - Overcoming immunologic incompatibility: transplanting the difficult to transplant 
      patient.
PG  - 474-81
AB  - Immunologic incompatibilities between donor and recipient have limited the access 
      to renal transplantation for many patients. Previously the presence of 
      donor-specific alloantibodies directed against donor major histocompatibility 
      complex (MHC) antigens or natural antibodies directed against donor ABO blood 
      group antigens was considered an absolute contraindication to renal 
      transplantation. However, with the current understanding of humoral immune 
      responses, superior immunosuppressive agents, and improved diagnosis and 
      treatment of antibody-mediated rejection, renal transplantation can be safely 
      performed with outstanding results despite the presence of donor-specific 
      antibody. In this review we discuss the biology of antibody-mediated rejection 
      and sensitization. We discuss the diagnostic tests necessary to characterize the 
      type, affinity, and avidity of the donor-directed antibodies. Current methods for 
      performing renal transplants across ABO and human leukocyte antigen 
      (HLA)-sensitized barriers are covered, including the potential morbidities. The 
      rest of the review focuses on advances in managing these antibodies to increase 
      the likelihood of receiving a deceased donor kidney or allow transplantation from 
      a living donor against whom one has a prohibitive antibody.
FAU - Crew, R John
AU  - Crew RJ
AD  - Department of Medicine, Columbia University College of Physicians and Surgeons, 
      New York, New York 10032, USA.
FAU - Ratner, Lloyd E
AU  - Ratner LE
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Semin Dial
JT  - Seminars in dialysis
JID - 8911629
RN  - 0 (ABO Blood-Group System)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - ABO Blood-Group System
MH  - Blood Group Incompatibility/diagnosis/*immunology
MH  - Graft Rejection/diagnosis/*prevention & control
MH  - Graft Survival
MH  - Histocompatibility Testing/methods
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Kidney Transplantation/*immunology
MH  - Transplantation Conditioning/*methods
RF  - 54
EDAT- 2006/01/10 09:00
MHDA- 2006/03/17 09:00
CRDT- 2006/01/10 09:00
PHST- 2006/01/10 09:00 [pubmed]
PHST- 2006/03/17 09:00 [medline]
PHST- 2006/01/10 09:00 [entrez]
AID - SDI092 [pii]
AID - 10.1111/j.1525-139X.2005.00092.x [doi]
PST - ppublish
SO  - Semin Dial. 2005 Nov-Dec;18(6):474-81. doi: 10.1111/j.1525-139X.2005.00092.x.