PMID- 22790073
OWN - NLM
STAT- MEDLINE
DCOM- 20130423
LR  - 20220408
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 17
IP  - 4
DP  - 2012 Aug
TI  - HLA incompatible renal transplantation.
PG  - 386-92
LID - 10.1097/MOT.0b013e328356132b [doi]
AB  - PURPOSE OF REVIEW: Human leukocyte antigen (HLA) sensitization is a major public 
      health problem that limits access to renal transplantation for 30% of the 
      patients awaiting a kidney transplant. This review describes the transplantation 
      modalities available to the sensitized patient and discusses aspects of the 
      donor/recipient phenotypes that determine the most suitable option for a 
      particular patient. RECENT FINDINGS: Patients, who undergo desensitization have a 
      significant survival benefit compared with similar patients, who either remain on 
      dialysis or wait for a compatible donor. The initial donor-specific antibody 
      (DSA) strength is the best predictor of outcome and cost of desensitization. In 
      small, uncontrolled single center trials, complement inhibitors, proteasome 
      inhibitors and anti-CD20 have been used to both prevent and reverse 
      antibody-mediated rejection (AMR). SUMMARY: With new agents being introduced into 
      the armamentarium, which have not undergone rigorous investigation, it is 
      important to emphasize that plasmapheresis, intravenous immunoglobulin, increased 
      sharing, and kidney-paired donation are very effective strategies for 
      transplanting sensitized patients. However, a significant population of patients 
      will not benefit from either kidney-paired donation or desensitization and will 
      require a hybrid technique in which the goal of matching is to reduce the 
      strength of the DSA to facilitate desensitization.
FAU - Montgomery, Robert A
AU  - Montgomery RA
AD  - Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, 
      USA. rmonty@jhmi.edu
FAU - Warren, Daniel S
AU  - Warren DS
FAU - Segev, Dorry L
AU  - Segev DL
FAU - Zachary, Andrea A
AU  - Zachary AA
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)
SB  - IM
MH  - Desensitization, Immunologic
MH  - Directed Tissue Donation
MH  - Graft Rejection/immunology/*prevention & control
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Kidney Transplantation/*immunology
EDAT- 2012/07/14 06:00
MHDA- 2013/04/24 06:00
CRDT- 2012/07/14 06:00
PHST- 2012/07/14 06:00 [entrez]
PHST- 2012/07/14 06:00 [pubmed]
PHST- 2013/04/24 06:00 [medline]
AID - 00075200-201208000-00010 [pii]
AID - 10.1097/MOT.0b013e328356132b [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2012 Aug;17(4):386-92. doi: 
      10.1097/MOT.0b013e328356132b.