Managing the highly sensitized transplant recipient and B cell tolerance.
The detection of anti-donor-HLA antibodies in a renal allograft recipient's serum, either at the time of or after transplantation, is usually associated with specific antibody-mediated clinical syndromes. These can be divided temporally into three categories: hyperacute rejection, acute humoral rejection and chronic humoral rejection. With the identification of new immunosuppressive drug combinations, more-effective control of alloantibody production has been recently achieved in humans. Thus, prevention and/or treatment of antibody-mediated allograft injury are now possible. Ultimately, the induction of mixed hematopoietic chimerism may allow us to overcome the problem of allosensitization and accept an allograft without chronic immunosuppression.
Baid
S
S
Renal and Transplantation Units, and Histocompatibility Laboratory, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Saidman
S L
SL
Tolkoff-Rubin
N
N
Williams
W W
WW
Delmonico
F L
FL
Cosimi
A B
AB
Pascual
M
M
D000818:Animals; D001402:B-Lymphocytes / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007114:Immunization / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007518:Isoantibodies / Q000096:biosynthesis; D023001:Transplantation Tolerance / Q000276:immunology*
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies