title: Permissible mismatches, acceptable mismatches, and tolerance: new trends in decision making.
abstract: The identification of permissible mismatches that do not impair graft survival might open exciting new possibilities which we should follow up. The data are preliminary, but if true, 50% of the patients in Eurotransplant could get a kidney with optimal graft survival. For sensitized patients we might consider adding a CTLp test, with and without CsA, to our serological crossmatch tests. This might be beneficial especially for interpreting noncurrent crossmatches. Information on the activation status of the donor-specific cytotoxic T cells on the day of transplantation (primed or not, CsA-resistant or not) provides additional information which could facilitate the decision of whether or not to accept a mismatched graft, even in case of donor-specific antibodies in historical sera. Under certain circumstances, haplotype-shared blood transfusions can induce transplantation tolerance. Time will tell whether the determination of the level of donor-derived soluble HLA antigens might be helpful in an early diagnosis of rejection. It might become a new device to monitor homograft reactivity and to identify the patients in whom immunosuppression could be decreased or even discontinued.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Rood
authors.forename: E L
authors.initials: EL
authors.lastname: Lagaaij
authors.forename: I
authors.initials: I
authors.lastname: Doxiadis
authors.forename: D
authors.initials: D
authors.lastname: Roelen
authors.forename: G
authors.initials: G
authors.lastname: Persijn
authors.forename: F
authors.initials: F
authors.lastname: Claas
mesh_terms: D001803:Blood Transfusion; D016572:Cyclosporine / Q000494:pharmacology; D003657:Decision Making; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000032:analysis; D006648:Histocompatibility; D006801:Humans; D007108:Immune Tolerance; D016030:Kidney Transplantation / Q000276:immunology*; D008213:Lymphocyte Activation; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
chemical_list: D006680:HLA Antigens; D016572:Cyclosporine