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Desensitization protocols for prospective pediatric renal transplant recipients
Nizam Mamode1,2, Stephen D Marks3
1Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK. nizam.mamode@gstt.nhs.uk.
Pediatric Nephrology (Berlin, Germany)
|June 9, 2016
Summary
Desensitization protocols are crucial for pediatric kidney transplant candidates with positive crossmatches. This approach addresses sensitization from prior transplants, transfusions, or infections, improving transplant outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- HLA Matching
Background:
- Children awaiting renal transplantation often develop sensitization due to prior transplants, blood product transfusions, infections, or immunizations.
- Sensitization in pediatric patients, unlike adults, rarely stems from pregnancy.
- The definition of HLA-incompatible (HLAi) renal transplantation is inconsistent in literature, with a positive cross-match being the most accurate criterion.
Discussion:
- Positive crossmatches, including flow cytometric or complement-dependent cytotoxic assays, define HLA-incompatible renal transplantation.
- Pediatric renal transplant recipients with donor-specific antibodies (DSA) but a negative cross-match, while higher risk, are not strictly categorized as HLA-incompatible.
- Desensitization protocols offer a viable strategy for managing sensitized pediatric patients to improve renal allograft survival.
Key Insights:
- Accurate definition of HLA-incompatible renal transplantation relies on positive crossmatch results.
- Sensitization in pediatric kidney transplant candidates has diverse causes, necessitating tailored management.
- Implementing desensitization protocols is vital for children with positive crossmatches facing renal transplantation.
Outlook:
- Further research into optimizing desensitization protocols for pediatric populations is warranted.
- Standardizing the definition of HLA-incompatible transplantation will enhance comparative studies and clinical practice.
- Improved management of sensitized pediatric patients can lead to better long-term renal allograft function and survival.
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