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HLA incompatible renal transplantation.

Robert A Montgomery¹, Daniel S Warren, Dorry L Segev

¹Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. rmonty@jhmi.edu

Current Opinion in Organ Transplantation

|July 14, 2012

Summary

This summary is machine-generated.

Kidney transplant patients with human leukocyte antigen (HLA) sensitization benefit from desensitization therapies. Strategies like plasmapheresis and kidney-paired donation improve outcomes, but some patients require hybrid approaches.

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Area of Science:

Nephrology
Immunology
Transplantation Science

Background:

Human leukocyte antigen (HLA) sensitization is a significant barrier to kidney transplantation, affecting 30% of patients on waiting lists.
Understanding donor/recipient phenotypes is crucial for selecting appropriate transplantation strategies for sensitized individuals.

Purpose of the Study:

To review available kidney transplantation modalities for sensitized patients.
To discuss donor/recipient factors influencing the choice of transplantation strategy.
To highlight the benefits of desensitization and alternative approaches.

Main Methods:

Review of current literature on kidney transplantation for sensitized patients.
Analysis of desensitization protocols and their efficacy.
Discussion of strategies including plasmapheresis, intravenous immunoglobulin, and kidney-paired donation.

Main Results:

Desensitization significantly improves patient survival compared to remaining on dialysis or waiting for a compatible donor.
Initial donor-specific antibody (DSA) strength is a key predictor of desensitization outcomes and costs.
Emerging therapies like complement inhibitors, proteasome inhibitors, and anti-CD20 show promise in preventing/reversing antibody-mediated rejection (AMR).

Conclusions:

Plasmapheresis, intravenous immunoglobulin, and kidney-paired donation are effective for transplanting sensitized patients.
A subset of patients may not benefit from standard kidney-paired donation or desensitization, necessitating hybrid techniques.
Reducing DSA strength through matching is vital for facilitating desensitization in complex cases.