PMID- 21666478
OWN - NLM
STAT- MEDLINE
DCOM- 20111115
LR  - 20110714
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 16
IP  - 4
DP  - 2011 Aug
TI  - Using donor exchange paradigms with desensitization to enhance transplant rates 
      among highly sensitized patients.
PG  - 439-43
LID - 10.1097/MOT.0b013e32834897c1 [doi]
AB  - PURPOSE OF REVIEW: Many sensitized patients have willing live donors but are 
      unable to use them because of a human leukocyte antigen (HLA) incompatibility. 
      The options for these patients include: remaining on the deceased-donor list, 
      entering a kidney-paired donation scheme, or undergoing desensitization with 
      high-dose IVIg or plasmapheresis and low-dose IVIg. RECENT FINDINGS: Mathematical 
      simulations verified by actual data from several national kidney-paired donation 
      (KPD) programs has shed light on which donor/recipient phenotypes are likely to 
      benefit from each transplant modality. Pairs that are easy to match are likely to 
      receive compatible kidneys in a KPD. Those who are hard to match may be better 
      served by desensitization. The phenotype which is both hard to match and hard to 
      desensitize due to board and strong HLA reactivity are most likely to be 
      transplanted by a hybrid modality utilizing desensitization after identifying a 
      more immunologically favorable donor in a KPD. SUMMARY: Recent outcomes from 
      desensitization in which starting donor-specific antibody strength is low have 
      been very good. For broadly sensitized patients with a high-strength cross-match, 
      searching for a better donor in a KPD pool can facilitate a safer, less 
      expensive, and more successful desensitization treatment course.
FAU - Montgomery, Robert A
AU  - Montgomery RA
AD  - Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, 
      USA. rmonty@jhmi.edu
FAU - Lonze, Bonnie E
AU  - Lonze BE
FAU - Jackson, Annette M
AU  - Jackson AM
LA  - eng
GR  - RC1 DK086731/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Desensitization, Immunologic/*methods
MH  - Graft Rejection/immunology/prevention & control
MH  - Graft Survival/drug effects
MH  - HLA Antigens/*immunology
MH  - Histocompatibility/*drug effects
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Isoantibodies/*immunology
MH  - Kidney Transplantation/*immunology
MH  - Living Donors/supply & distribution
MH  - *Plasmapheresis
MH  - Transplantation Tolerance/drug effects
MH  - Treatment Outcome
EDAT- 2011/06/15 06:00
MHDA- 2011/11/16 06:00
CRDT- 2011/06/14 06:00
PHST- 2011/06/14 06:00 [entrez]
PHST- 2011/06/15 06:00 [pubmed]
PHST- 2011/11/16 06:00 [medline]
AID - 10.1097/MOT.0b013e32834897c1 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2011 Aug;16(4):439-43. doi: 
      10.1097/MOT.0b013e32834897c1.