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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Sensitized renal transplant recipients: current protocols and future directions
1Department of Nephrology and Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA. gloor.james@mayo.edu
Nature Reviews. Nephrology
|March 18, 2010
Summary
Finding compatible donor kidneys for patients with high anti-human leukocyte antigen (HLA) antibodies is difficult. New protocols improve outcomes for kidney transplants, but antibody-mediated rejection remains a significant challenge.
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- Identifying suitable donor kidneys for transplant candidates with high levels of circulating anti-human leukocyte antigen (HLA) antibodies presents a significant challenge, leading to extended waiting times.
- Technological advancements allow for better characterization of anti-HLA antibody activity and its clinical impact, offering new insights.
Purpose of the Study:
- To review the challenges and advancements in kidney transplantation for patients with high levels of anti-HLA antibodies.
- To discuss the effectiveness and limitations of current protocols and emerging therapies for antibody-mediated rejection (AMR).
Main Methods:
- Review of technological advances in antibody characterization.
- Analysis of protocols for transplantation in patients with donor-specific antibodies.
- Evaluation of the incidence and impact of acute and subclinical antibody-mediated rejection.
- Discussion of novel therapeutic interventions under investigation.
Main Results:
- Protocols for transplanting patients with donor-specific antibodies demonstrate satisfactory early to intermediate-term allograft survival.
- Acute antibody-mediated rejection (AMR) occurs in 20-50% of antibody-incompatible kidney transplantations, negatively impacting allograft survival despite treatment.
- Subclinical AMR may affect positive-crossmatch transplantations, leading to chronic histological abnormalities and reduced allograft function.
Conclusions:
- While protocols have improved outcomes, AMR remains a significant hurdle in kidney transplantation.
- Emerging therapies like anti-C5 antibody blockade and proteasome inhibitor-mediated plasma cell depletion show promise for preventing acute AMR.
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