PMID- 38088373
OWN - NLM
STAT- MEDLINE
DCOM- 20240308
LR  - 20240308
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 29
IP  - 2
DP  - 2024 Apr 1
TI  - Advances in desensitization for human leukocyte antigen incompatible kidney 
      transplantation.
PG  - 104-120
LID - 10.1097/MOT.0000000000001131 [doi]
AB  - PURPOSE OF REVIEW: Human leukocyte antigen (HLA) sensitization is a major barrier 
      to kidney transplantation induced by exposure to alloantigens through pregnancy, 
      blood product exposure and previous transplantations. Desensitization strategies 
      are undertaken to improve the chances of finding compatible organ offers. 
      Standard approaches to desensitization include the use of plasmapheresis/low dose 
      intravenous immunoglobulin (IVIG) or high dose IVIG plus anti-CD20. However, 
      current methods to reduce HLA antibodies are not always successful, especially in 
      those with calculated panel reactive antibody 99-100%. RECENT FINDINGS: Newer 
      desensitization strategies such as imlifidase [immunoglobulin G (IgG) 
      endopeptidase] rapidly inactivates IgG molecules and creates an "antibody-free 
      zone", representing an important advancement in desensitization. However, 
      pathogenic antibodies rebound, increasing allograft injury that is not addressed 
      by imlifidase. Here, use of anti-IL-6R (tocilizumab) or anti-interleukin-6 
      (clazakizumab) could offer long-term control of B-memory and plasma cell DSA 
      responses to limit graft injury. Agents aimed at long-lived plasma cells 
      (anti-CD38 and anti-BCMAxCD3) could reduce or eliminate HLA-producing plasma 
      cells from marrow niches. Other agents such as complement inhibitors and novel 
      agents inhibiting the Fc neonatal receptor (FcRn) mediated IgG recycling will 
      likely find important roles in desensitization. SUMMARY: Use of these agents 
      alone or in combination will likely improve the efficacy and durability of 
      desensitization therapies, improving access to kidney transplantation for 
      immunologically disadvantaged patients.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Vo, Ashley
AU  - Vo A
AD  - Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, 
      California, USA.
FAU - Ammerman, Noriko
AU  - Ammerman N
FAU - Jordan, Stanley C
AU  - Jordan SC
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20231213
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Infant, Newborn
MH  - Humans
MH  - *Kidney Transplantation/adverse effects
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Graft Rejection/prevention & control
MH  - Immunosuppressive Agents/adverse effects
MH  - Antibodies
MH  - HLA Antigens
MH  - Desensitization, Immunologic
EDAT- 2023/12/13 12:44
MHDA- 2024/03/08 06:43
CRDT- 2023/12/13 08:50
PHST- 2024/03/08 06:43 [medline]
PHST- 2023/12/13 12:44 [pubmed]
PHST- 2023/12/13 08:50 [entrez]
AID - 00075200-202404000-00003 [pii]
AID - 10.1097/MOT.0000000000001131 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2024 Apr 1;29(2):104-120. doi: 
      10.1097/MOT.0000000000001131. Epub 2023 Dec 13.