title: Identification and therapeutic management of highly sensitized patients undergoing renal transplantation.
abstract: Sensitization is generally referred to as the development of alloantibodies, specifically anti-human leukocyte antigen (HLA) immunoglobulin G (IgG) antibodies, most commonly caused by pregnancy, blood transfusion or a previous transplant. Despite being a well known phenomenon, there has not been a general consensus on its definition, monitoring or management. Today, 25% of the patients waitlisted for kidney transplant in the US have a panel reactive antibody (PRA) of >10% while, in the Eurotransplant zone, 14% have a PRA of >5%. Sensitized patients have more difficulty in finding a well HLA-matched donor, and have a higher risk of experiencing longer waiting times, more rejection episodes and eventually inferior long-term graft or patient survival. We review the currently available strategies in identifying and managing highly sensitized patients undergoing renal transplantation. We discuss the progress and limitations in laboratory techniques to elaborate on challenges in defining sensitized patients. The main management options (i.e. the Acceptable Mismatch Program, donor exchange programmes and the desensitization approach) and their mechanisms, related policies, advantages and outcomes, as well as medications and methods being investigated, are updated. In addition, particular emphasis is given to sensitization prevention, a practice that is neglected with our increasing ability to suppress the immune system.
authors: Department of Nephrology, Charit Campus Mitte, Charit Universittsmedizin Berlin, Berlin, Germany.
authors: Lu
authors: L
authors: Huber
authors: Nils
authors: N
authors: Lachmann
authors: Michael
authors: M
authors: Dürr
authors: Mareen
authors: M
authors: Matz
authors: Lutz
authors: L
authors: Liefeldt
authors: Hans-H
authors: HH
authors: Neumayer
authors: Constanze
authors: C
authors: Schönemann
authors: Klemens
authors: K
authors: Budde
mesh_terms: D001787:Blood Group Incompatibility / Q000175:diagnosis / Q000517:prevention & control; D003888:Desensitization, Immunologic; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D010956:Plasmapheresis; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies