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Progress in Desensitization of the Highly HLA Sensitized Patient.

Abstract：

:The presence of HLA antibodies remains a significant and often impenetrable barrier to kidney transplantation, leading to increased morbidity and mortality for patients remaining on long-term dialysis. In recent years, a number of new approaches have been developed to overcome these barriers. Intravenous immunoglobulin (IVIG) remains the lynchpin of HLA desensitization therapy and has been shown in a prospective, randomized, placebo-controlled trial to improve transplantation rates. In addition, IVIG used in low doses with plasma exchange is a reliable protocol for desensitization. Another significant advancement was the addition of rituximab (anti-B-cell therapy) to IVIG and plasma exchange-based desensitization. This approach has significantly improved rates of transplantation and outcomes. There is limited experience with bortezomib (anti-plasma cell therapy) and eculizumab (complement inhibition) for desensitization. However, recent data from a completed trial of eculizumab failed to show a significant benefit for prevention of antibody-mediated rejection compared with standard therapy plus placebo, and bortezomib produced inconsistent results. There is a growing interest in developing new therapeutic agents for desensitization. Newer approaches that address antibody reduction with B-cell depletion are discussed.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Jordan SC,Choi J,Kahwaji J,Vo A

doi

10.1016/j.transproceed.2015.11.027

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

802-5

issue

3

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(16)00129-9

journal_volume

48

pub_type

杂志文章

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