[The highly sensitized patient. Therapeutic alternatives for kidney transplantation].
Patients become sensitized after exposure to non-self human leukocyte antigen (HLA) during pregnancy, blood transfusion, and organ transplantation. Performing transplantation in highly sensitized receptors represents a challenge for transplant programs, organ allocation organizations and usually patients are forced to stay on transplant waiting lists for many years and ultimately may never find a donor. There are various approaches that can be adopted in order to transplant these patients such as plasmapheresis, immunoadsorption, intravenous immune globulin, anti-thymocyte agents, monoclonal antibodies (anti CD-20) and splenectomy with similar results as obtained in non highly sensitized patients with the increased risk of severe and recurrent rejection which may carry implications for long-term graft outcomes. Thus a positive crossmatch test is not necessarily an absolute contraindication and allows access for transplantation.
Mancilla-Urrea
Eduardo
E
Departamento de Nefrología del Instituto Nacional de Cardiología Ignacio Chávez, México, DF. emulmps@mexis.com
D000961:Antilymphocyte Serum / Q000627:therapeutic use; D006648:Histocompatibility; D006801:Humans; D007114:Immunization; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D007163:Immunosorbent Techniques; D007165:Immunosuppression Therapy / Q000379:methods*; D007518:Isoantibodies / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology*; D010956:Plasmapheresis; D013156:Splenectomy; D016176:T-Lymphocyte Subsets / Q000276:immunology
D000961:Antilymphocyte Serum; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies