摘要
The presence of human-leukocyte antigen （HLA）-antibodies and blood group incompatibility remain a large barrier to kidney transplantation leading to increased morbidity and mortality on the transplant waiting list. Over the last decade a number of new approaches were developed to overcome these barriers. Intravenous immunoglobulin （IVIG） remains the backbone of HLA desensitization therapy and has been shown in a prospective, randomized, placebo controlled trial to improve transplantation rates. Excellent outcomes with the addition of rituximab （anti-B cell） to IVIG based desensitization have been achieved. There is limited experience with bortezomib （anti-plasma cell） and eculizumab （complement inhibition） for desensitization. However, these agents may be good adjuncts for patients who are broadly sensitized with strong, complement-fxing HLA antibodies. Excellent short and long-term outcomes have been achieved in ABO incompatible transplantation with the combination of antibody removal, B cell depletion, and pre-transplant immunosuppression. Kidney paired donation has emerged as a reasonable alternative for programs who cannot provide desensitization or in conjunction with desensitization. Future therapies directed toward cytokines that alter B cell proliferation are under investigation.
The presence of human-leukocyte antigen(HLA)-antibodies and blood group incompatibility remain a large barrier to kidney transplantation leading to increased morbidity and mortality on the transplant waiting list.Over the last decade a number of new approaches were developed to overcome these barriers.Intravenous immunoglobulin(IVIG) remains the backbone of HLA desensitization therapy and has been shown in a prospective,randomized,placebo controlled trial to improve transplantation rates.Excellent outcomes with the addition of rituximab(anti-B cell) to IVIG based desensitization have been achieved.There is limited experience with bortezomib(anti-plasma cell) and eculizumab(complement inhibition) for desensitization.However,these agents may be good adjuncts for patients who are broadly sensitized with strong,complement-fixing HLA antibodies.Excellent short and long-term outcomes have been achieved in ABO incompatible transplantation with the combination of antibody removal,B cell depletion,and pre-transplant immunosuppression.Kidney paired donation has emerged as a reasonable alternative for programs who cannot provide desensitization or in conjunction with desensitization.Future therapies directed toward cytokines that alter B cell proliferation are under investigation.
