PMID- 27234740
OWN - NLM
STAT- MEDLINE
DCOM- 20170106
LR  - 20181202
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 48
IP  - 3
DP  - 2016 Apr
TI  - Progress in Desensitization of the Highly HLA Sensitized Patient.
PG  - 802-5
LID - S0041-1345(16)00129-9 [pii]
LID - 10.1016/j.transproceed.2015.11.027 [doi]
AB  - The presence of HLA antibodies remains a significant and often impenetrable 
      barrier to kidney transplantation, leading to increased morbidity and mortality 
      for patients remaining on long-term dialysis. In recent years, a number of new 
      approaches have been developed to overcome these barriers. Intravenous 
      immunoglobulin (IVIG) remains the lynchpin of HLA desensitization therapy and has 
      been shown in a prospective, randomized, placebo-controlled trial to improve 
      transplantation rates. In addition, IVIG used in low doses with plasma exchange 
      is a reliable protocol for desensitization. Another significant advancement was 
      the addition of rituximab (anti-B-cell therapy) to IVIG and plasma exchange-based 
      desensitization. This approach has significantly improved rates of 
      transplantation and outcomes. There is limited experience with bortezomib 
      (anti-plasma cell therapy) and eculizumab (complement inhibition) for 
      desensitization. However, recent data from a completed trial of eculizumab failed 
      to show a significant benefit for prevention of antibody-mediated rejection 
      compared with standard therapy plus placebo, and bortezomib produced inconsistent 
      results. There is a growing interest in developing new therapeutic agents for 
      desensitization. Newer approaches that address antibody reduction with B-cell 
      depletion are discussed.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Jordan, S C
AU  - Jordan SC
AD  - Transplant Immunotherapy Program, Comprehensive Transplant Center, Cedars-Sinai 
      Medical Center, Los Angeles, California. Electronic address: 
      stan.jordan@cshs.org.
FAU - Choi, J
AU  - Choi J
AD  - Transplant Immunotherapy Program, Comprehensive Transplant Center, Cedars-Sinai 
      Medical Center, Los Angeles, California.
FAU - Kahwaji, J
AU  - Kahwaji J
AD  - Transplant Immunotherapy Program, Comprehensive Transplant Center, Cedars-Sinai 
      Medical Center, Los Angeles, California.
FAU - Vo, A
AU  - Vo A
AD  - Transplant Immunotherapy Program, Comprehensive Transplant Center, Cedars-Sinai 
      Medical Center, Los Angeles, California.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Desensitization, Immunologic/*methods
MH  - Graft Rejection/*immunology
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Kidney Transplantation
MH  - Plasma Exchange
MH  - Rituximab/therapeutic use
EDAT- 2016/05/29 06:00
MHDA- 2017/01/07 06:00
CRDT- 2016/05/29 06:00
PHST- 2015/10/15 00:00 [received]
PHST- 2015/11/11 00:00 [accepted]
PHST- 2016/05/29 06:00 [entrez]
PHST- 2016/05/29 06:00 [pubmed]
PHST- 2017/01/07 06:00 [medline]
AID - S0041-1345(16)00129-9 [pii]
AID - 10.1016/j.transproceed.2015.11.027 [doi]
PST - ppublish
SO  - Transplant Proc. 2016 Apr;48(3):802-5. doi: 10.1016/j.transproceed.2015.11.027.