Can we prevent donor-specific antibodies from developing after ABO-incompatible kidney transplantation?
The burden of chronic kidney disease is increasing worldwide and its costs are skyrocketing, particularly for those with end-stage kidney disease (ESKD). Thus, kidney transplantation needs to be available to as many as ESKD patients as possible. In countries where a donor swap or a donor-chain program is not feasible, ABO-incompatible (ABO-i) and/or HLA incompatible (HLAi) programs have been developed. In the setting of ABOi kidney transplantation, pretransplant desensitization is mandatory; this is based on the removal of isoagglutinins by plasmapheresis or immunoadsorption, and often using splenectomy (SPx) or, more recently, rituximab (RTx) infusion instead. Because RTx and SPx interfere with B-cell function, one wonders whether these desensitization protocols alter the occurrence of post-transplant donor-specific alloantibodies.
1] Department of Nephrology, Dialysis and Organ Transplantation, Centre Hospitalier Universitaire Rangueil, TSA 50032, Toulouse, France [2] Inserm U563 IFR-BMT, Centre Hospitalier Universitaire Purpan, Toulouse, France [3] Université Paul Sabatier, Faculté de Médecine de Rangueil, Toulouse, France.
Lionel
L
Rostaing
1] Department of Nephrology, Dialysis and Organ Transplantation, Centre Hospitalier Universitaire Rangueil, TSA 50032, Toulouse, France [2] Inserm U563 IFR-BMT, Centre Hospitalier Universitaire Purpan, Toulouse, France [3] Université Paul Sabatier, Faculté de Médecine de Rangueil, Toulouse, France.
Nassim
N
Kamar
D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation; D008297:Male; D000069283:Rituximab; D013156:Splenectomy
D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab