PMID- 28284304
OWN - NLM
STAT- MEDLINE
DCOM- 20180223
LR  - 20180329
IS  - 1557-9816 (Electronic)
IS  - 0955-470X (Linking)
VI  - 31
IP  - 1
DP  - 2017 Jan
TI  - Kidney paired exchange and desensitization: Strategies to transplant the 
      difficult to match kidney patients with living donors.
PG  - 29-34
LID - S0955-470X(16)30124-0 [pii]
LID - 10.1016/j.trre.2017.01.003 [doi]
AB  - With organs in short supply, only a limited number of kidney transplants can be 
      performed a year. Live donor donation accounts for 1/3rd of all kidney 
      transplants performed in the United States. Unfortunately, not every donor 
      recipient pair is feasible because of Human leukocyte antigen (HLA) sensitization 
      and ABO incompatibility. To overcome these barriers to transplant, strategies 
      such as kidney paired donation (KPD) and desensitization have been developed. KPD 
      is the exchange of donors between at least two incompatible donor-recipient pairs 
      such that they are now compatible. Desensitization is the removal of circulating 
      donor specific antibodies to prevent graft rejection. Regardless of the treatment 
      strategy, highly sensitized patients whose calculated panel reactive antibody 
      (cPRA) is >/=95% remain difficult to transplant with match rates as low as 15% in 
      KPD pools. Desensitization has proved to be difficult in those with high antibody 
      titers. A novel approach is the combination of both KPD and desensitization to 
      facilitate compatible and successful transplantation. A highly sensitized patient 
      can be paired with a better immunological match in the KPD pool and subsequently 
      desensitized to a lesser degree. This article reviews the current progress in KPD 
      and desensitization and their use as a combined therapy.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Pham, Thomas A
AU  - Pham TA
AD  - Department of Surgery, Division of Hepatobiliary Surgery and Abdominal 
      Transplantation, Keck School of Medicine at University of Southern California, 
      1510 San Pablo St Suite 514, Los Angeles, CA 90033. Electronic address: 
      Thomas.pham@med.usc.edu.
FAU - Lee, Jacqueline I
AU  - Lee JI
AD  - Department of Surgery, Division of Abdominal Transplantation, Stanford University 
      School of Medicine, 750 Welch Ave Suite 200, Palo Alto, CA 94304. Electronic 
      address: Jlee26@stanford.edu.
FAU - Melcher, Marc L
AU  - Melcher ML
AD  - Department of Surgery, Division of Abdominal Transplantation, Stanford University 
      School of Medicine, 750 Welch Ave Suite 200, Palo Alto, CA 94304. Electronic 
      address: melcherm@stanford.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170124
PL  - United States
TA  - Transplant Rev (Orlando)
JT  - Transplantation reviews (Orlando, Fla.)
JID - 8804364
SB  - IM
MH  - Desensitization, Immunologic/*methods
MH  - Donor Selection/*methods
MH  - Female
MH  - Graft Rejection/immunology
MH  - Graft Survival/immunology
MH  - Humans
MH  - Kidney Transplantation/adverse effects/*methods
MH  - *Living Donors
MH  - Male
MH  - Prognosis
MH  - Transplantation Immunology/*physiology
MH  - Treatment Outcome
EDAT- 2017/03/13 06:00
MHDA- 2018/02/24 06:00
CRDT- 2017/03/13 06:00
PHST- 2016/11/13 00:00 [received]
PHST- 2017/01/06 00:00 [accepted]
PHST- 2017/03/13 06:00 [entrez]
PHST- 2017/03/13 06:00 [pubmed]
PHST- 2018/02/24 06:00 [medline]
AID - S0955-470X(16)30124-0 [pii]
AID - 10.1016/j.trre.2017.01.003 [doi]
PST - ppublish
SO  - Transplant Rev (Orlando). 2017 Jan;31(1):29-34. doi: 10.1016/j.trre.2017.01.003. 
      Epub 2017 Jan 24.