Article: Modern approaches to incompatible kidney transplantation.
World journal of nephrology
2014 Volume 4, Issue 3, Page(s) 354–362
Abstract: ... a large barrier to kidney transplantation leading to increased morbidity and mortality on the transplant ... 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 ...
| Abstract | 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. |
|---|---|
| Language | English |
| Publishing date | 2014-09-01 |
| Publishing country | United States |
| Document type | Journal Article ; Review |
| ISSN | 2220-6124 |
| ISSN | 2220-6124 |
| DOI | 10.5527/wjn.v4.i3.354 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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