Kidney transplantation in highly sensitized recipients
In kidney transplantation (KT), overcoming donor shortage is particularly challenging in patients with preexisting donor-specific antibodies (DSAs) against human leukocyte antigen (HLA), called HLA-incompatible KT (HLAi KT), carrying the risk of rejection and allograft loss. Thus, it is necessary to...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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The Korean Society of Nephrology
2021-09-01
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| Series: | Kidney Research and Clinical Practice |
| Subjects: | |
| Online Access: | http://www.krcp-ksn.org/upload/pdf/j-krcp-21-012.pdf |
| _version_ | 1818716750368210944 |
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| author | Yohan Park Eun Jeong Ko Byung Ha Chung Chul Woo Yang |
| author_facet | Yohan Park Eun Jeong Ko Byung Ha Chung Chul Woo Yang |
| author_sort | Yohan Park |
| collection | DOAJ |
| description | In kidney transplantation (KT), overcoming donor shortage is particularly challenging in patients with preexisting donor-specific antibodies (DSAs) against human leukocyte antigen (HLA), called HLA-incompatible KT (HLAi KT), carrying the risk of rejection and allograft loss. Thus, it is necessary to accurately evaluate the degree of sensitization before HLAi KT, and undertake appropriate pretreatment strategies. To determine the degree of sensitization, complement-dependent cytotoxicity has been the only method employed; the development of a method using flow cytometry further improved the test sensitivity. However, these tests present disadvantages, including the need for living cells, with a solid-phase assay developed to resolve this problem. Currently, the method using Luminex (Luminex Corp.) is widely used in clinical practice. As this method measures DSAs using single antigen beads, it is possible to classify immunological risks by measuring the type and amount of DSAs. Furthermore, there have been major advances in methods that involve DSA removal before HLAi KT. In the early stages of desensitization, plasmapheresis and intravenous immunoglobulins were the main treatment methods employed; however, the introduction of CD20 monoclonal antibody and proteasome inhibitors further increased the success rate of desensitization. Currently, HLAi KT has been established as an important transplant method, but an understanding of DSAs and a novel desensitization treatment are warranted. |
| first_indexed | 2024-12-17T19:24:13Z |
| format | Article |
| id | doaj.art-26fe4ad4b83b4d449032c33b0c48a4d8 |
| institution | Directory Open Access Journal |
| issn | 2211-9132 2211-9140 |
| language | English |
| last_indexed | 2024-12-17T19:24:13Z |
| publishDate | 2021-09-01 |
| publisher | The Korean Society of Nephrology |
| record_format | Article |
| series | Kidney Research and Clinical Practice |
| spelling | doaj.art-26fe4ad4b83b4d449032c33b0c48a4d82022-12-21T21:35:25ZengThe Korean Society of NephrologyKidney Research and Clinical Practice2211-91322211-91402021-09-0140335537010.23876/j.krcp.21.0126054Kidney transplantation in highly sensitized recipientsYohan Park0Eun Jeong Ko1Byung Ha Chung2Chul Woo Yang3 Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea Division of Nephrology, Department of Internal Medicine and Transplantation Research Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaIn kidney transplantation (KT), overcoming donor shortage is particularly challenging in patients with preexisting donor-specific antibodies (DSAs) against human leukocyte antigen (HLA), called HLA-incompatible KT (HLAi KT), carrying the risk of rejection and allograft loss. Thus, it is necessary to accurately evaluate the degree of sensitization before HLAi KT, and undertake appropriate pretreatment strategies. To determine the degree of sensitization, complement-dependent cytotoxicity has been the only method employed; the development of a method using flow cytometry further improved the test sensitivity. However, these tests present disadvantages, including the need for living cells, with a solid-phase assay developed to resolve this problem. Currently, the method using Luminex (Luminex Corp.) is widely used in clinical practice. As this method measures DSAs using single antigen beads, it is possible to classify immunological risks by measuring the type and amount of DSAs. Furthermore, there have been major advances in methods that involve DSA removal before HLAi KT. In the early stages of desensitization, plasmapheresis and intravenous immunoglobulins were the main treatment methods employed; however, the introduction of CD20 monoclonal antibody and proteasome inhibitors further increased the success rate of desensitization. Currently, HLAi KT has been established as an important transplant method, but an understanding of DSAs and a novel desensitization treatment are warranted.http://www.krcp-ksn.org/upload/pdf/j-krcp-21-012.pdfalloantibodiesbortezomibhla antigenskidney transplantationplasmapheresisrituximab |
| spellingShingle | Yohan Park Eun Jeong Ko Byung Ha Chung Chul Woo Yang Kidney transplantation in highly sensitized recipients Kidney Research and Clinical Practice alloantibodies bortezomib hla antigens kidney transplantation plasmapheresis rituximab |
| title | Kidney transplantation in highly sensitized recipients |
| title_full | Kidney transplantation in highly sensitized recipients |
| title_fullStr | Kidney transplantation in highly sensitized recipients |
| title_full_unstemmed | Kidney transplantation in highly sensitized recipients |
| title_short | Kidney transplantation in highly sensitized recipients |
| title_sort | kidney transplantation in highly sensitized recipients |
| topic | alloantibodies bortezomib hla antigens kidney transplantation plasmapheresis rituximab |
| url | http://www.krcp-ksn.org/upload/pdf/j-krcp-21-012.pdf |
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