title: Desensitization for solid organ and hematopoietic stem cell transplantation.
abstract: Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft.
authors: Department of Medicine, Division of Immunogenetics and Transplantation Immunology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Andrea A
authors: AA
authors: Zachary
authors: Mary S
authors: MS
authors: Leffell
mesh_terms: D000818:Animals; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006648:Histocompatibility; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016377:Organ Transplantation / Q000009:adverse effects; D023001:Transplantation Tolerance; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: desensitization; donor-specific antibodies; hematopoietic stem cell transplantation; intravenous immunoglobulin; plasmapheresis; solid organ transplantation