Posttransplant immunosuppression in highly sensitized patients.
Recent desensitization protocols using the combination of plasmapheresis (PP) or immunoadsorption to remove donor-specific anti-HLA antibodies (DSA) and/or intravenous immunoglobulin (IVIG) and rituximab to downregulate antibody-mediated immune responses have made kidney transplantation feasible by abrogating cross-match positivity. Despite good short-term patient and graft survival, acute antibody-mediated rejection (AMR) continued to be an important barrier seen in 20-30% of patients receiving desensitization protocols and it is still not clear which protocol (high-dose IVIG, PP/low-dose IVIG), what type of induction treatment (thymoglobulin, anti-IL-2R antibodies, alemtuzumab), or addition of rituximab is better for the prevention of early acute AMR. Future prospective, multicenter, and randomized trials are required to decide the ideal protocol for sensitized patients.
Akalin
Enver
E
Renal Division and Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, N.Y., USA. enver.akalin@mountsinai.org
D001402:B-Lymphocytes / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D010956:Plasmapheresis; D013156:Splenectomy; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies