title: Therapeutic apheresis in kidney transplantation: a review of renal transplant immunobiology and current interventions with apheresis medicine.
abstract: Transplantation is the treatment of choice for end stage renal disease. Kidney transplants convey both a significant survival advantage to the individual recipient as well as cost savings to the medical system. Circulating alloantibodies directed against donor human leukocyte antigens and blood group antigens are fairly common among potential recipients. They are known to injure allografts, shorten allograft survival, and limit access to kidney transplantation. Hence, screening for pretransplant alloantibodies using complement dependent cytotoxic cross-matching and more sensitive techniques such as the solid phase assays, have become routine in an attempt to avoid incompatible donor-recipient pairs and risk stratify those with donor specific antibodies (DSA). By removing harmful antibodies, therapeutic apheresis (TA) has become a critical tool for improving access to transplantation in cases where the immunologic risk had previously been considered unacceptable. It has also allowed us to transplant across the barrier of ABO blood group incompatibility and expand the pool of donors with reasonable success. Furthermore, it is an important tool in the treatment of antibody-mediated rejection. Advanced apheresis technologies, such as immunoadsorption, and the use of TA in combination with innovative paired-donor exchange programs, offer the potential to further improve access and outcomes, minimizing the short comings of one single form of therapy alone.
authors: Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors: Angie
authors: A
authors: Nishio-Lucar
authors: Rasheed A
authors: RA
authors: Balogun
authors: Scott
authors: S
authors: Sanoff
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D001781:Blood Component Removal / Q000379:methods / Q000639:trends; D001787:Blood Group Incompatibility / Q000276:immunology; D046148:Donor Selection; D005260:Female; D006082:Graft Enhancement, Immunologic / Q000379:methods*; D006084:Graft Rejection / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007676:Kidney Failure, Chronic / Q000191:economics / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics / Q000276:immunology / Q000379:methods; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies