[Immunology and immunosuppression in kidney transplantation. ABO and HLA incompatible kidney transplantation].
OBJECTIVE
To perform a state of the art about immunological features in renal transplantation, immunosuppressive drugs and their mechanisms of action and immunologically high risk transplantations such as ABO and HLA-incompatible transplantation.


METHODS
An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "allogenic response; allograft; immunosuppression; ABO incompatible transplantation; donor specific antibodies; HLA incompatible; desensitization; kidney transplantation". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 4717 articles. After reading titles and abstracts, 141 were included in the text, based on their relevance.


RESULTS
The considerable step in comprehension and knowledge allogeneic response this last few years allowed a better used of immunosuppression and the discover of news immunosuppressive drugs. In the first part of this article, the allogeneic response will be described. The different classes of immunosuppressive drugs will be presented and the actual management of immunosuppression will be discussed. Eventually, the modalities and results of immunologically high-risk transplantations such as ABO and HLA incompatible transplantations will be reported.


CONCLUSIONS
The knowledge and the control of allogeneic response to allogeneic graft allowed the development of renal transplantation.
Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France. Electronic address: francois.kleinclauss@univ-fcomte.fr.
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F
Kleinclauss
Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France.
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A
Frontczak
Service d'urologie et transplantation rénale, CHU de Grenoble, 38700 Grenoble, France.
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Terrier
Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34000 Montpellier, France.
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Thuret
Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France.
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MO
Timsit
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008213:Lymphocyte Activation; D014181:Transplantation Immunology
D000017:ABO Blood-Group System; D006680:HLA Antigens
ABO incompatible transplantation; Allogenic response; Allograft; Allogreffe; HLA incompatible transplantation; Immunosuppression; Réponse allogénique; Transplantation ABO-incompatible; Transplantation HLA incompatible