Kidney transplantation across HLA and ABO antibody barriers

• Verfasst von: Becker, Luis Eduardo [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Verfasst von: Morath, Christian [VerfasserIn]
• Titel: Kidney transplantation across HLA and ABO antibody barriers
• Verf.angabe: Luis E. Becker, Caner Süsal, and Christian Morath
• Jahr: 2013
• Umfang: 10 S.
• Fussnoten: Gesehen am 03.12.2020 ; DOI funktioniert nicht
• Titel Quelle: Enthalten in: Current opinion in organ transplantation
• Ort Quelle: Philadelphia, Pa. : Lippincott Williams & Wilkins, 1996
• Jahr Quelle: 2013
• Band/Heft Quelle: 18(2013), 4, Seite 445-454
• ISSN Quelle: 1531-7013
• DOI: doi:10.1097/MOT.0b013e3283636c20
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: ABO Blood-Group System
• Sach-SW: Blood Grouping and Crossmatching
• Sach-SW: Histocompatibility Testing
• Sach-SW: HLA Antigens
• Sach-SW: Humans
• Sach-SW: Kidney Failure, Chronic
• Sach-SW: Kidney Transplantation
• Sach-SW: Living Donors
• Sach-SW: Transplantation, Homologous
• K10plus-PPN: 174192989X

Abstract

PURPOSE OF REVIEW: A significant number of kidney transplantations in industrialized countries is currently performed over human leukocyte antigen (HLA) or ABO antibody barriers after living donation to encounter the increasing shortage of organs from deceased donors. Although patients with moderate titers of anti-A/B antibodies may easily be desensitized with no negative impact on allograft survival, recipients with high titers and HLA sensitized patients demonstrate a substantial risk for antibody-mediated rejection, limiting long-term outcomes. - RECENT FINDINGS: The use of powerful desensitization strategies including plasmapheresis and immunoadsorption, extended therapeutic options such as the application of the recently introduced complement inhibitors, and refined antibody detection techniques may further facilitate transplantations, especially in the HLA-sensitized kidney transplant recipient. On the contrary, special strategies such as the Eurotransplant Acceptable Mismatch Program or kidney paired exchange help improving long-term outcomes in these difficult to transplant patients by circumventing the HLA (or ABO) antibody barrier. - SUMMARY: As compared with waiting for a compatible deceased donor organ, HLA and ABO incompatible transplantations performed in experienced centers have become a reasonable alternative for end-stage kidney disease patients with an incompatible live donor. Whenever possible, however, the transplantation should be performed between ABO compatible donor-recipient pairs in the absence of positive crossmatch results.