PMID- 20234355
OWN - NLM
STAT- MEDLINE
DCOM- 20100812
LR  - 20220419
IS  - 1759-507X (Electronic)
IS  - 1759-5061 (Linking)
VI  - 6
IP  - 5
DP  - 2010 May
TI  - Sensitized renal transplant recipients: current protocols and future directions.
PG  - 297-306
LID - 10.1038/nrneph.2010.34 [doi]
AB  - The identification of suitable donor kidneys for transplant candidates with high 
      levels of circulating antibodies against human leukocyte antigen (HLA) is a major 
      challenge and results in prolonged waiting times for transplantation. 
      Technological advances in antibody characterization have permitted a more 
      comprehensive assessment of anti-HLA antibody activity, as well as providing new 
      insights into the clinical effect of HLA antibody class and specificity. 
      Protocols have been developed that enable successful transplantation in patients 
      with donor-specific antibodies (anti-HLA antibodies reactive against their 
      donors). These protocols provide satisfactory early to intermediate-term 
      allograft survival, and constitute an important advance in transplantation. 
      Nevertheless, acute antibody-mediated rejection (AMR) remains a significant 
      challenge, occurring in 20-50% of antibody-incompatible kidney transplantations. 
      Although therapy directed toward lowering donor-specific antibody activity seems 
      to be successful in reversing acute AMR, this condition still has an important 
      negative impact on allograft survival. In addition, subclinical AMR seems to 
      complicate a substantial proportion of positive-crossmatch transplantations even 
      in the absence of allograft dysfunction, and may result in chronic histological 
      abnormalities and shortened allograft function. New interventions for preventing 
      acute AMR, such as anti-C5 antibody-mediated complement blockade and proteasome 
      inhibitor-mediated plasma cell depletion, are promising therapeutic avenues 
      currently under investigation.
FAU - Gloor, James
AU  - Gloor J
AD  - Department of Nephrology and Internal Medicine, Mayo Clinic, 200 1st Street SW, 
      Rochester, MN 55905, USA. gloor.james@mayo.edu
FAU - Stegall, Mark D
AU  - Stegall MD
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20100316
PL  - England
TA  - Nat Rev Nephrol
JT  - Nature reviews. Nephrology
JID - 101500081
RN  - 0 (Complement C5)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Proteasome Inhibitors)
SB  - IM
MH  - Adsorption
MH  - Antibody Specificity
MH  - Complement C5/immunology
MH  - Desensitization, Immunologic
MH  - Graft Rejection/*immunology/pathology/*prevention & control
MH  - Graft Survival
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Kidney Transplantation/*immunology
MH  - Plasma Exchange
MH  - Proteasome Inhibitors
MH  - Risk Factors
MH  - Tissue Donors
MH  - Transplantation Immunology/*immunology
RF  - 112
EDAT- 2010/03/18 06:00
MHDA- 2010/08/13 06:00
CRDT- 2010/03/18 06:00
PHST- 2010/03/18 06:00 [entrez]
PHST- 2010/03/18 06:00 [pubmed]
PHST- 2010/08/13 06:00 [medline]
AID - nrneph.2010.34 [pii]
AID - 10.1038/nrneph.2010.34 [doi]
PST - ppublish
SO  - Nat Rev Nephrol. 2010 May;6(5):297-306. doi: 10.1038/nrneph.2010.34. Epub 2010 
      Mar 16.