PMID- 31815787
OWN - NLM
STAT- MEDLINE
DCOM- 20201023
LR  - 20211204
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 25
IP  - 1
DP  - 2020 Feb
TI  - Immunosuppression in sensitized recipients.
PG  - 80-85
LID - 10.1097/MOT.0000000000000721 [doi]
AB  - PURPOSE OF REVIEW: Due to a substantial lack of kidney donor organs and an 
      increasing number of sensitized recipients, a growing number of kidney 
      transplantations has to be performed across human leukocyte antigen (HLA) and ABO 
      barriers. These transplantations carry an inherent risk of antibody-mediated 
      rejection (AMR) with subsequently impaired graft and patient survival. This 
      review focuses on new developments in desensitization strategies and dedicated 
      programs for sensitized allograft recipients. RECENT FINDINGS: Whereas 
      ABO-incompatible kidney transplantation using rituximab-based desensitization 
      achieves long-term survival rates comparable with ABO-compatible kidney 
      transplantation, HLA-incompatible living kidney transplantation shows no definite 
      survival advantage as compared with staying on the waiting list for an 
      HLA-compatible organ. To overcome HLA-incompatibilities dedicated programs for 
      highly sensitized recipients (such as the Eurotransplant Acceptable Mismatch 
      program) have been established. For optimal graft outcome, these programs should 
      be based on proven acceptable mismatches and not just on avoiding unacceptable 
      antigens. Novel desensitizing agents (e.g. complement inhibitors) that 
      specifically inhibit the molecular pathways of AMR have shown promising results 
      in HLA-incompatible kidney transplantation in smaller studies. SUMMARY: Despite 
      ever more challenging conditions, kidney transplantation in highly sensitized 
      patients can be achieved with the use of dedicated programs, well established 
      desensitizing agents and new drugs that specifically inhibit the molecular 
      processes of AMR.
FAU - Echterdiek, Fabian
AU  - Echterdiek F
AD  - Department of Nephrology, Hypertension and Autoimmune Disorders, Klinikum 
      Stuttgart, Stuttgart, Germany.
FAU - Latus, Joerg
AU  - Latus J
FAU - Schwenger, Vedat
AU  - Schwenger V
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
SB  - IM
MH  - Female
MH  - Humans
MH  - Immunosuppression Therapy/*methods
MH  - Kidney Transplantation/*methods
MH  - Male
EDAT- 2019/12/10 06:00
MHDA- 2020/10/24 06:00
CRDT- 2019/12/10 06:00
PHST- 2019/12/10 06:00 [pubmed]
PHST- 2020/10/24 06:00 [medline]
PHST- 2019/12/10 06:00 [entrez]
AID - 00075200-202002000-00014 [pii]
AID - 10.1097/MOT.0000000000000721 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2020 Feb;25(1):80-85. doi: 
      10.1097/MOT.0000000000000721.