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Orthotopic Left Lung Transplantation in Rats

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Transplanting the Untransplantable.

Courtenay M Holscher¹, Kyle R Jackson¹, Dorry L Segev²

¹Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|July 1, 2019

Summary

Kidney transplantation is more accessible for highly sensitized patients due to the Kidney Allocation System and kidney paired donation programs. Advances in desensitization and immunosuppression improve outcomes for previously untransplantable candidates.

Keywords:

ABO incompatibility HLA incompatibility ILDKT Kidney Allocation System Kidney transplantation antibody-mediated rejection (AMR)cPRA crossmatch desensitization donor-specific antibodies (DSA)end-stage renal disease (ESRD)graft loss kidney paired donation (KPD)renal transplant recipient review transplant waitlist

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Area of Science:

Nephrology
Transplantation Immunology

Background:

The Kidney Allocation System (KAS) has been updated to improve deceased donor kidney matching for highly sensitized candidates.
Kidney paired donation (KPD) programs have expanded, incorporating incompatible donor chains to facilitate transplantation.
Advances in desensitization protocols and immunosuppressive therapies enhance the management of antibody-mediated rejection.

Purpose of the Study:

To review recent advancements in kidney transplantation for highly sensitized or
untransplantable
candidates.
To discuss the impact of KAS, KPD, and medical advancements on transplantation accessibility.
To recommend an approach for managing sensitized kidney transplant candidates.

Main Methods:

Review of current literature and clinical practices related to kidney allocation, paired donation, and desensitization.
Analysis of the effects of KAS criteria on wait times and transplant rates for sensitized individuals.
Discussion of strategies for overcoming immunological barriers in kidney transplantation.

Main Results:

KAS now prioritizes candidates with high panel-reactive antibody (PRA) levels and expands kidney allocation to blood group B recipients.
KPD programs offer improved options for candidates with incompatible living donors through incompatible and "more compatible" chains.
Enhanced desensitization and immunosuppression effectively manage donor-specific antibodies and prevent antibody-mediated rejection.

Conclusions:

Highly sensitized candidates are no longer considered
untransplantable
due to blood group or antibody incompatibility.
Individualized counseling on wait times and early referral to expert centers are crucial for sensitized candidates.
A comprehensive approach integrating KAS, KPD, and advanced medical therapies optimizes outcomes for challenging kidney transplant cases.