PMID- 21155718
OWN - NLM
STAT- MEDLINE
DCOM- 20110526
LR  - 20101215
IS  - 1399-0039 (Electronic)
IS  - 0001-2815 (Linking)
VI  - 77
IP  - 1
DP  - 2011 Jan
TI  - Desensitization: achieving immune detente.
PG  - 3-8
LID - 10.1111/j.1399-0039.2010.01596.x [doi]
AB  - Antibodies to donor HLA (human leukocyte antigen) and/or ABO antigens were a 
      contraindication to transplantation of most organs for decades. Desensitization 
      protocols have shown the ability to produce reduction of such antibodies 
      sufficient to achieve a successful transplantation. The two major protocols in 
      use are high-dose IVIg or plasmapheresis with low-dose IVIg. The protocols differ 
      in the basic treatment and, to some degree, in their application, but both use 
      standard immunosuppressive agents as well as more recently developed adjunctive 
      agents such as cell-depleting antibodies. Graft and patient survival with both 
      types of protocol are comparable to that of non-sensitized patients, although 
      desensitized patients do have a higher incidence of antibody-mediated rejection 
      (AMR). Antibodies to donor antigens may persist after transplantation, and while 
      the initial antibody titer represents the level of difficulty for successful 
      desensitization, the strength of antibodies that persist after transplantation 
      reflects the risk of AMR. Current protocols do not eliminate B cell clones 
      specific for donor HLA; therefore, desensitized patients remain at an increased 
      risk of antibody rebound if patients experience pro-inflammatory events. 
      Therefore, ongoing antibody monitoring is crucial for early detection of 
      antibody-mediated graft injury. Importantly, the results of numerous programs 
      show that ABOi- and HLA-positive crossmatch renal transplantation, with proper 
      desensitization, can be performed successfully. Further, in addition to 
      increasing the rate of transplantation among sensitized patients, desensitization 
      is providing insight into immunoregulatory processes and may provide information 
      useful in diseases involving immune dysfunction.
CI  - (c) 2010 John Wiley & Sons A/S.
FAU - Zachary, A A
AU  - Zachary AA
AD  - Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, 
      MD, USA. aaz@jhmi.edu
FAU - Eng, H S
AU  - Eng HS
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Tissue Antigens
JT  - Tissue antigens
JID - 0331072
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
SB  - IM
MH  - *Desensitization, Immunologic
MH  - Graft Rejection/immunology/*prevention & control
MH  - HLA Antigens/immunology
MH  - Humans
MH  - Immunoglobulins, Intravenous/immunology
MH  - Immunologic Factors/immunology
EDAT- 2010/12/16 06:00
MHDA- 2011/05/27 06:00
CRDT- 2010/12/16 06:00
PHST- 2010/12/16 06:00 [entrez]
PHST- 2010/12/16 06:00 [pubmed]
PHST- 2011/05/27 06:00 [medline]
AID - 10.1111/j.1399-0039.2010.01596.x [doi]
PST - ppublish
SO  - Tissue Antigens. 2011 Jan;77(1):3-8. doi: 10.1111/j.1399-0039.2010.01596.x.