[Transplantation strategies in immunized and hyperimmunized patients].
The rate of access to transplantation of hyperimmunized patients has improved thanks to a modification of the organ allocation rule in 2002 and the initiation of the Acceptable Mismatch program. Transplantation of immunized patients must be now preceded by a fine description of the characteristics of pretransplantation immunization using sensitive techniques and by an indispensable clinical and biological discussion to choose the best transplantation strategy, taking into account the risk/benefit balance for the patient of each strategy. Whichever transplantation strategy is adopted, immunosuppression should be adapted to the immunological status of the patient, often using the new therapeutic strategies (IVIg, rituximab, plasma exchange) with a specific follow-up, notably for anti-HLA antibodies, checking their evolution post treatment.
Antoine
C
C
Service de Néphrologie et de transplantation rénale, Hôpital Saint-Louis, 1, avenue Claude Vellefaux, 75010 Paris, France. corinne.antoine@sls.aphp.fr
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000077552:Basiliximab; D002986:Clinical Trials as Topic; D000077561:Daclizumab; D006084:Graft Rejection / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D007114:Immunization; D007074:Immunoglobulin G / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000032:analysis / Q000276:immunology; D018579:Patient Selection; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012086:Reoperation; D013601:T-Lymphocytes; D009927:Tissue and Organ Procurement; D014181:Transplantation Immunology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077561:Daclizumab