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Clinical aspects of sensitization
S Katznelson1, S Bhaduri, J M Cecka
1Division of Nephrology, University of California, Davis UNOS Scientific Renal Transplant Registry, USA.
Clinical Transplants
|January 1, 1997
Summary
Broad sensitization in organ transplant recipients has decreased, likely due to fewer blood transfusions. Improved immunosuppression has boosted graft survival, even in sensitized patients, and reduced acute rejection episodes.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Broad sensitization, a significant challenge in organ transplantation, has seen evolving trends.
- Pretransplant blood transfusions, previous pregnancies, and failed allografts are identified as key factors increasing sensitization risk.
- Specific patient subgroups, including males, nulliparous females, and different racial groups (Asians, Whites, African Americans), exhibit varying susceptibilities to sensitization.
Purpose of the Study:
- To analyze trends in broad sensitization and its impact on organ transplant outcomes over an 8-year period.
- To investigate the relationship between sensitization, acute rejection episodes, and graft survival.
- To evaluate the effectiveness of different immunosuppressive strategies, including induction therapy, in managing broadly sensitized patients.
Main Methods:
- Retrospective analysis of patient data over an 8-year period.
- Comparison of graft survival rates and acute rejection episodes between sensitized and unsensitized patient groups.
- Assessment of the impact of pretransplant factors (blood transfusions, pregnancies) and demographic characteristics on sensitization incidence.
- Evaluation of immunosuppressive regimens, including antilymphocyte antibody induction, Neoral, mycophenolate, and prednisone.
Main Results:
- A significant decrease in broad sensitization incidence observed, correlated with reduced pretransplant blood transfusions.
- Improved graft survival rates for broadly sensitized patients (76% at 2 years) compared to earlier periods (66%).
- Increased incidence of acute rejection episodes with higher sensitization levels (46% vs. 38% in unsensitized).
- Association found between broad sensitization and delayed graft function.
- Newer immunosuppressive protocols (Neoral, MMF, FK506) are replacing traditional antibody induction therapy for broadly sensitized patients.
Conclusions:
- Decreased blood transfusions and improved immunosuppression have positively impacted outcomes for broadly sensitized transplant recipients.
- While acute rejection risk increases with sensitization, newer immunosuppressive regimens may offer better graft survival.
- The combination of Neoral, mycophenolate, and prednisone shows promise as an optimal regimen for broadly sensitized individuals, potentially surpassing traditional antibody induction therapy.