PMID- 23838650
OWN - NLM
STAT- MEDLINE
DCOM- 20130919
LR  - 20220321
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 18
IP  - 4
DP  - 2013 Aug
TI  - Kidney transplantation across HLA and ABO antibody barriers.
PG  - 445-54
LID - 10.1097/MOT.0b013e3283636c20 [doi]
AB  - PURPOSE OF REVIEW: A significant number of kidney transplantations in 
      industrialized countries is currently performed over human leukocyte antigen 
      (HLA) or ABO antibody barriers after living donation to encounter the increasing 
      shortage of organs from deceased donors. Although patients with moderate titers 
      of anti-A/B antibodies may easily be desensitized with no negative impact on 
      allograft survival, recipients with high titers and HLA sensitized patients 
      demonstrate a substantial risk for antibody-mediated rejection, limiting 
      long-term outcomes. RECENT FINDINGS: The use of powerful desensitization 
      strategies including plasmapheresis and immunoadsorption, extended therapeutic 
      options such as the application of the recently introduced complement inhibitors, 
      and refined antibody detection techniques may further facilitate 
      transplantations, especially in the HLA-sensitized kidney transplant recipient. 
      On the contrary, special strategies such as the Eurotransplant Acceptable 
      Mismatch Program or kidney paired exchange help improving long-term outcomes in 
      these difficult to transplant patients by circumventing the HLA (or ABO) antibody 
      barrier. SUMMARY: As compared with waiting for a compatible deceased donor organ, 
      HLA and ABO incompatible transplantations performed in experienced centers have 
      become a reasonable alternative for end-stage kidney disease patients with an 
      incompatible live donor. Whenever possible, however, the transplantation should 
      be performed between ABO compatible donor-recipient pairs in the absence of 
      positive crossmatch results.
FAU - Becker, Luis E
AU  - Becker LE
AD  - Division of Nephrology, University of Heidelberg, Heidelberg, Germany.
FAU - Susal, Caner
AU  - Susal C
FAU - Morath, Christian
AU  - Morath C
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 (ABO Blood-Group System)
RN  - 0 (HLA Antigens)
SB  - IM
MH  - ABO Blood-Group System/*immunology
MH  - Blood Grouping and Crossmatching
MH  - HLA Antigens/*immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Kidney Failure, Chronic/immunology/surgery
MH  - Kidney Transplantation/*immunology
MH  - Living Donors
MH  - Transplantation, Homologous
EDAT- 2013/07/11 06:00
MHDA- 2013/09/21 06:00
CRDT- 2013/07/11 06:00
PHST- 2013/07/11 06:00 [entrez]
PHST- 2013/07/11 06:00 [pubmed]
PHST- 2013/09/21 06:00 [medline]
AID - 00075200-201308000-00011 [pii]
AID - 10.1097/MOT.0b013e3283636c20 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2013 Aug;18(4):445-54. doi: 
      10.1097/MOT.0b013e3283636c20.