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Desensitisation strategies in high-risk children before kidney transplantation

Ankit Sharma1,2, Anne M Durkan3,4,5

  • 1Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, 2145, Australia.

Pediatric Nephrology (Berlin, Germany)
|January 15, 2018
PubMed

Insights

Pediatric kidney transplant recipients face challenges due to increasing sensitization. An immunological risk stratification approach is recommended to manage sensitized children awaiting transplantation.

Area of Science:

  • Nephrology
  • Immunology
  • Pediatric Transplantation

Background:

  • Renal replacement therapy in children increasingly involves transplantation.
  • Rising re-transplantation rates lead to more sensitized children on waiting lists.
  • Inconsistent definitions of sensitization complicate treatment strategies.

Purpose of the Study:

  • To review current methods for sensitization prevention, assessment, and management in pediatric kidney transplantation.
  • To highlight the lack of evidence-based desensitization data in children.
  • To present available therapies for desensitization.

Main Methods:

  • Discussion of sensitization prevention strategies.
  • Review of assessment and management protocols.
  • Exploration of paired exchange programs and desensitization protocols.

Main Results:

  • Limited evidence exists for desensitization in adults, and none in children.
  • Information on currently used desensitization therapies is presented.
  • The need for standardized definitions and approaches is evident.

Conclusions:

  • Further research is needed on sensitization prevention strategies in children.
  • Epitope-based matching in organ allocation requires investigation.
  • Controlled studies are necessary to determine optimal desensitization regimens.
Abstract

Keywords:
Antibody mediated rejectionDesensitisationImmunoglobulinKidneyPlasmapheresisRituximabTransplant

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