PMID- 20885325
OWN - NLM
STAT- MEDLINE
DCOM- 20140513
LR  - 20181202
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 15
IP  - 6
DP  - 2010 Dec
TI  - Mature wines are better: CDC as the leading method to define highly sensitized 
      patients.
PG  - 716-9
LID - 10.1097/MOT.0b013e3283402beb [doi]
AB  - PURPOSE OF REVIEW: Highly sensitized patients on the kidney waitlist have the 
      least chance to receive a cross-match negative offer and, once transplanted, have 
      a lower patient and graft survival. Until recently, complement-dependent 
      cytotoxicity (CDC) was the standard method to define if a patient is sensitized 
      or not. The introduction of more sensitive solid-phase assays (SPAs) to detect 
      human leukocyte antigen (HLA) antibodies has led to a dramatic increase in the 
      number of the patients on the waitlist. This review advocates the use of the 
      'old-fashioned' CDC to define the degree of sensitization and as the tool for 
      allocation of kidneys to highly sensitized patients. RECENT FINDINGS: 
      HLA-antibody screening using CDC is a cumbersome method that needs a high degree 
      of expertise. SPA is easier, more reproducible and accessible to a large number 
      of laboratories. The dogma that donor-specific antibodies (DSAs) are a 
      contraindication for transplantation disappeared. The presence of SPA-DSA is 
      rather a risk factor for complications than a contraindication. The opinion on 
      the clinical relevance of SPA-DSA differs between the centers. SUMMARY: A proper 
      designation of highly sensitized patients is crucial since it impacts the 
      allocation. CDC-DSA is generally considered a contraindication for 
      transplantation, whereas SPA-DSA remains controversial. The lack of consensus 
      between centers is partly due to the heterogeneity of the HLA antibodies 
      involved, the lack of standardization in antibody titer, the immunoglobulin 
      (sub)class and the epitopes recognized. Until the issues are resolved, one should 
      be careful to use the information generated in SPA for the allocation of kidneys 
      and focus on the 'old CDC' that has shown to be effective in the past.
FAU - Doxiadis, Ilias I N
AU  - Doxiadis II
AD  - aEurotransplant Reference Laboratory, The Netherlands bDepartment of 
      Immunohaematology and Blood, Transfusion, Leiden University Medical Center, 
      Leiden, The Netherlands.
FAU - Roelen, Dave
AU  - Roelen D
FAU - Claas, Frans H J
AU  - Claas FH
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (HLA Antigens)
RN  - 0 (Isoantibodies)
RN  - 9007-36-7 (Complement System Proteins)
SB  - IM
MH  - Complement System Proteins/immunology
MH  - *Cytotoxicity Tests, Immunologic
MH  - Graft Rejection/immunology
MH  - Graft Survival/immunology
MH  - HLA Antigens/*immunology
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - Isoantibodies/immunology
MH  - *Kidney Transplantation
EDAT- 2010/10/05 06:00
MHDA- 2014/05/14 06:00
CRDT- 2010/10/02 06:00
PHST- 2010/10/02 06:00 [entrez]
PHST- 2010/10/05 06:00 [pubmed]
PHST- 2014/05/14 06:00 [medline]
AID - 10.1097/MOT.0b013e3283402beb [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2010 Dec;15(6):716-9. doi: 
      10.1097/MOT.0b013e3283402beb.