The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation
Seeking to develop immunosuppression regimens that would take into account the patient's level of sensitization to the antigens of the main histocompatibility complex, we studied 123 patients after kidney transplantation. Depending on the choice of immunosuppressive therapy, two groups were for...
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| Format: | Article |
| Language: | English |
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N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department
2018-03-01
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| Series: | Трансплантология (Москва) |
| Subjects: | |
| Online Access: | https://www.jtransplantologiya.ru/jour/article/view/214 |
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| author | N. V. Borovkova A. V. Pinchuk N. V. Shmarina N. V. Doronina R. V. Storozhev |
| author_facet | N. V. Borovkova A. V. Pinchuk N. V. Shmarina N. V. Doronina R. V. Storozhev |
| author_sort | N. V. Borovkova |
| collection | DOAJ |
| description | Seeking to develop immunosuppression regimens that would take into account the patient's level of sensitization to the antigens of the main histocompatibility complex, we studied 123 patients after kidney transplantation. Depending on the choice of immunosuppressive therapy, two groups were formed. The study group included 55 patients who received the immunosuppression regimen adapted to their HLA sensitization level. In the comparison group, 68 patients received baseline immunosuppression, including calcineurin inhibitors, mycophenolic acid preparations, and corticosteroids. AntiHLA antibody detection was performed by assessing the mean fluorescence intensity (MFI) on the Luminex platform when patient's placing on the transplant waiting list. It was found that highly HLA-sensitized recipients should receive antithymocyte polyclonal antibodies with or without plasmapheresis immediately after surgery in order to prevent the rejection reaction. The moderately HLA-sensitized patients should receive the baseline immunosuppression in combination with administration of monoclonal antibodies (simulect); the polyclonal antibodies should be administered only if necessary (in decreased diuresis rate, increased creatinine, etc.). In unsensitized patients, the baseline immunosuppression is enough to induce tolerance. Thus, the administration of immunosuppressive therapy adapted to the pre-existing HLA-sensitization level can significantly improve the treatment oucomes in kidney transplant recipients in the post-transplant period. |
| first_indexed | 2024-03-12T04:55:53Z |
| format | Article |
| id | doaj.art-8529604db04f44e3beadc531b27c2caa |
| institution | Directory Open Access Journal |
| issn | 2074-0506 2542-0909 |
| language | English |
| last_indexed | 2025-03-14T10:22:42Z |
| publishDate | 2018-03-01 |
| publisher | N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department |
| record_format | Article |
| series | Трансплантология (Москва) |
| spelling | doaj.art-8529604db04f44e3beadc531b27c2caa2025-03-02T11:07:31ZengN.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare DepartmentТрансплантология (Москва)2074-05062542-09092018-03-01101354110.23873/2074-0506-2018-10-1-35-41204The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantationN. V. Borovkova0A. V. Pinchuk1N. V. Shmarina2N. V. Doronina3R. V. Storozhev4N.V. Sklifosovsky Research Institute for Emergency MedicineN.V. Sklifosovsky Research Institute for Emergency MedicineN.V. Sklifosovsky Research Institute for Emergency MedicineN.V. Sklifosovsky Research Institute for Emergency MedicineN.V. Sklifosovsky Research Institute for Emergency MedicineSeeking to develop immunosuppression regimens that would take into account the patient's level of sensitization to the antigens of the main histocompatibility complex, we studied 123 patients after kidney transplantation. Depending on the choice of immunosuppressive therapy, two groups were formed. The study group included 55 patients who received the immunosuppression regimen adapted to their HLA sensitization level. In the comparison group, 68 patients received baseline immunosuppression, including calcineurin inhibitors, mycophenolic acid preparations, and corticosteroids. AntiHLA antibody detection was performed by assessing the mean fluorescence intensity (MFI) on the Luminex platform when patient's placing on the transplant waiting list. It was found that highly HLA-sensitized recipients should receive antithymocyte polyclonal antibodies with or without plasmapheresis immediately after surgery in order to prevent the rejection reaction. The moderately HLA-sensitized patients should receive the baseline immunosuppression in combination with administration of monoclonal antibodies (simulect); the polyclonal antibodies should be administered only if necessary (in decreased diuresis rate, increased creatinine, etc.). In unsensitized patients, the baseline immunosuppression is enough to induce tolerance. Thus, the administration of immunosuppressive therapy adapted to the pre-existing HLA-sensitization level can significantly improve the treatment oucomes in kidney transplant recipients in the post-transplant period.https://www.jtransplantologiya.ru/jour/article/view/214kidney transplantationhla antibodiesimmunosuppression therapy |
| spellingShingle | N. V. Borovkova A. V. Pinchuk N. V. Shmarina N. V. Doronina R. V. Storozhev The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation Трансплантология (Москва) kidney transplantation hla antibodies immunosuppression therapy |
| title | The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation |
| title_full | The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation |
| title_fullStr | The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation |
| title_full_unstemmed | The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation |
| title_short | The choice of immunosuppressive therapy depending on the level of anti-HLA antibodies in kidney transplantation |
| title_sort | choice of immunosuppressive therapy depending on the level of anti hla antibodies in kidney transplantation |
| topic | kidney transplantation hla antibodies immunosuppression therapy |
| url | https://www.jtransplantologiya.ru/jour/article/view/214 |
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