PMID- 19001810
OWN - NLM
STAT- MEDLINE
DCOM- 20090212
LR  - 20151119
IS  - 0302-5144 (Print)
IS  - 0302-5144 (Linking)
VI  - 162
DP  - 2009
TI  - Therapeutic strategies in management of the highly HLA-sensitized and 
      ABO-incompatible transplant recipients.
PG  - 13-26
LID - 10.1159/000170864 [doi]
AB  - Intravenous immunoglobulin (IVIG) products are derived from pooled human plasma 
      and have been used for the treatment of primary immunodeficiency disorders for 
      more than 24 years. Shortly after their introduction, IVIG products were found to 
      be effective in the treatment of autoimmune and inflammatory disorders. Rituximab 
      (anti-CD20, anti-B-cell monoclonal antibody) has also shown efficacy in the 
      treatment of autoimmune and inflammatory disorders. We have recently described a 
      beneficial effect of the combination of IVIG + rituximab on the reduction of 
      anti-human leukocyte antigen (HLA) antibodies with subsequent improvement in 
      rates of transplantation for highly HLA-sensitized patients as well as a potent 
      anti-inflammatory effect that is beneficial in the treatment of antibody-mediated 
      rejection. These advancements have enabled patients previously considered poor or 
      unreasonable candidates for transplantation to receive a successful transplant. 
      Alternative approaches to IVIG/rituximab-based desensitization include the 
      addition of plasmapheresis and possible splenectomy. Furthermore, new 
      advancements in detecting donor-specific anti-body and assessment of 
      antibody-mediated injury to allografts (C4d staining) allow for early detection 
      of antibody-mediated rejection and early implementation of IVIG/rituximab therapy 
      to prevent allograft loss.
CI  - Copyright (c) 2009 S. Karger AG, Basel.
FAU - Jordan, Stanley C
AU  - Jordan SC
AD  - Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, 
      Calif., USA. sjordan@cshs.org
FAU - Peng, Alice
AU  - Peng A
FAU - Vo, Ashley A
AU  - Vo AA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20081031
PL  - Switzerland
TA  - Contrib Nephrol
JT  - Contributions to nephrology
JID - 7513582
RN  - 0 (ABO Blood-Group System)
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Isoantibodies)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - ABO Blood-Group System/*immunology
MH  - Antibodies, Monoclonal/*therapeutic use
MH  - Antibodies, Monoclonal, Murine-Derived
MH  - Blood Group Incompatibility/*prevention & control
MH  - HLA Antigens/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunoglobulins, Intravenous/adverse effects/*therapeutic use
MH  - Isoantibodies/*immunology
MH  - Kidney Transplantation/immunology
MH  - Plasmapheresis
MH  - Rituximab
MH  - Splenectomy
RF  - 62
EDAT- 2008/11/13 09:00
MHDA- 2009/02/13 09:00
CRDT- 2008/11/13 09:00
PHST- 2008/11/13 09:00 [pubmed]
PHST- 2009/02/13 09:00 [medline]
PHST- 2008/11/13 09:00 [entrez]
AID - 000170864 [pii]
AID - 10.1159/000170864 [doi]
PST - ppublish
SO  - Contrib Nephrol. 2009;162:13-26. doi: 10.1159/000170864. Epub 2008 Oct 31.