PMID- 22541614
OWN - NLM
STAT- MEDLINE
DCOM- 20120829
LR  - 20120430
IS  - 1944-7930 (Electronic)
IS  - 1539-6509 (Linking)
VI  - 13
IP  - 71
DP  - 2012 Apr
TI  - Evolving paradigms for desensitization in managing broadly HLA sensitized 
      transplant candidates.
PG  - 267-73
AB  - The broadly human leukocyte antigen (HLA) sensitized patient awaiting organ 
      transplantation remains a persistent and significant problem for transplant 
      medicine. Sensitization occurs as a consequence of exposure to HLA antigens 
      through pregnancy, blood and platelet transfusions, and previous transplants. 
      Early experience with desensitization protocols coupled with improved diagnostics 
      for donor-specific antibodies (DSAs) and renal pathology have greatly improved 
      transplant rates and outcomes for patients once considered un-transplantable or 
      at high risk for poor outcomes. More recent advances have occurred through 
      implementation of a national allocation system requiring the entering of 
      unacceptable antigens that reduces the rate of crossmatch positivity. Current 
      desensitization therapies include high-dose intravenous immunoglobulin (IVIG), 
      plasma exchange (PLEX) with low-dose IVIG, and IVIG combined with rituximab. 
      Developing therapies include proteasome inhibitors aimed at plasma cells and 
      modifiers of complement-mediated injury. Here we discuss the important 
      advancements in desensitization including defining the risk for antibody-mediated 
      rejection prior to transplantation and the evolution of therapies aimed at 
      reducing the impact of antibody injury on allografts.
FAU - Reinsmoen, Nancy L
AU  - Reinsmoen NL
AD  - Comprehensive Transplant Center and HLA Laboratory, Cedars-Sinai Medical Center, 
      Los Angeles, California 90048, USA. nancy.reinsmoen@cshs.org
FAU - Lai, Chi-Hung
AU  - Lai CH
FAU - Vo, Ashley
AU  - Vo A
FAU - Jordan, Stanley C
AU  - Jordan SC
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Discov Med
JT  - Discovery medicine
JID - 101250006
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Adult
MH  - Desensitization, Immunologic/*methods
MH  - Female
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Kidney Transplantation/immunology
EDAT- 2012/05/01 06:00
MHDA- 2012/08/30 06:00
CRDT- 2012/05/01 06:00
PHST- 2012/05/01 06:00 [entrez]
PHST- 2012/05/01 06:00 [pubmed]
PHST- 2012/08/30 06:00 [medline]
PST - ppublish
SO  - Discov Med. 2012 Apr;13(71):267-73.