Incompatible kidney transplantation: lessons from a decade of desensitization and paired kidney exchange
- PDF / 238,282 Bytes
- 8 Pages / 439.37 x 666.142 pts Page_size
- 7 Downloads / 178 Views
Incompatible kidney transplantation: lessons from a decade of desensitization and paired kidney exchange Daniel S. Warren • Robert A. Montgomery
Published online: 20 January 2010 Ó Springer Science+Business Media, LLC 2010
Abstract Human leukocyte antigen (HLA) sensitization and ABO incompatibility continue to pose significant barriers to further expansion of live donor renal transplantation. However, the recent development of effective desensitization protocols and creative paired donation strategies demonstrates that the presence of circulating donor HLA-specific antibodies and the use of ABO incompatible organs should no longer be considered contraindications for renal transplantation. It is estimated that as many as 6,000 patients on the kidney transplant waiting list have incompatible living donors and could benefit from these treatments. Furthermore, as our understanding of these treatment modalities has improved, it is now possible to predict whether desensitization, kidney paired donation or a combination of both will provide an individual patient with their best chance for successful renal transplantation. Keywords Plasmapheresis Intravenous immunoglobulin IVIG ABO incompatible Positive crossmatch Kidney Transplantation Kidney paired donation
Renal transplantation is widely recognized as the optimal therapy for patients with end stage renal disease (ESRD) [1]. Unfortunately, the gap between patients awaiting kidney transplantation and transplantable organs grows every day and only a relatively small portion of patients with ESRD are transplanted in any given year. Many believe that the best way to reduce the shortage in organ availability is through increased utilization of kidneys from living donors. Development of the laparoscopic nephrectomy eliminated one major disincentive to living donation by significantly decreasing the pain, prolonged hospitalization, lost wages, and poor cosmetic results associated with the open flank renal procurement procedure [2–4]. However, HLA sensitization and ABO incompatibility continue to pose significant barriers to further expansion of living donation as the presence of circulating donor HLA-specific antibodies and the use of ABO incompatible organs D. S. Warren R. A. Montgomery (&) Department of Surgery, Johns Hopkins University, 720 Rutland Ave, Ross Building Room 765, Baltimore, MD 21205, USA e-mail: [email protected]
258
Immunol Res (2010) 47:257–264
have long been considered as contraindications for renal transplantation. In both situations, the donor-specific antibody (DSA) response, directed against donor HLA or blood group antigens, results in a high incidence of hyperacute or acute antibody-mediated rejection (AMR) and subsequent loss of the graft [5–8]. Alloantibodies develop following exposure to foreign HLA molecules through pregnancy, blood transfusion, or previous transplants. The development of the complementdependent cytotoxic crossmatch (?XM), which indicates the presence of donor-specific alloantibodies in the serum of a potential r
Data Loading...
