Current approaches to the management of highly sensitized kidney transplant patients

Süsal, Caner; Morath, Christian

doi:10.1111/j.1399-0039.2011.01638.x

Cited by 21 publications

(15 citation statements)

References 59 publications

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“…; Genzyme, Cambridge, MA, USA) in four patients. The latter patients received a median of 2.5 (2)(3)(4) doses of a median of 113 (75-125) mg of thymoglobulin with a target lymphocyte count of less than 100/nL. Rituximab (Roche, Basel, Switzerland) was administered at a single dose of 375 mg/m 2 , corresponding to a median dose of 645 (100-800) mg, immediately after the last preoperative IA treatment on day -1, when all CDC and ELISA crossmatches had become negative.…”

Section: Immunosuppressionmentioning

confidence: 99%

“…Successful living donor kidney transplantation in patients with a positive crossmatch and donor-specific antibodies (DSA) requires specific measures, such as plasmapheresis or intravenous immunoglobulins [1,2]. Despite these measures, impaired graft survival rates were reported in desensitized living donor kidney transplant recipients [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

Morath¹,

Beimler²,

Opelz³

et al. 2012

Transplant International

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Summary Living donor kidney transplantation in crossmatch‐positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor‐specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti‐CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex‐DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post‐transplant IA treatments. At last visit, after a median follow‐up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex‐DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody‐mediated rejection was diagnosed in three patients. One allograft was lost after the second post‐transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.

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Section: Immunosuppressionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

Morath¹,

Beimler²,

Opelz³

et al. 2012

Transplant International

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“…One is to remove most of their HLA antibodies prior to transplantation by various methods, i.e. desensitization (17). Further improvements in this area are needed such as better methods to prevent renewed production of antibodies after they have been removed.…”

Section: Organ Transplantationmentioning

confidence: 99%

On the future of HLA

Thorsby

2011

Tissue Antigens

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As the immunobiological function of the HLA (human leucocyte antigen) class I and II molecules was revealed, we have seen an explosive development of the HLA field. Today, the HLA complex occupies a central position in basic and clinical immunology. In this Opinion article, I will briefly discuss some challenges which in my opinion are more important than others in the near future of HLA, with a focus on products of the classical HLA class I and II genes. Matching for HLA antigens will continue to be of importance in organ and hematopoietic stem cell transplantations. In the latter field, induction of graft-versus-leukemia effects will receive greater attention, where HLA will play a central role. It is anticipated that we will see an extensive development in our knowledge of the etiology and pathogenesis of autoimmune diseases, where some HLA class I and II genes by far are the strongest predisposing genes. To predict and prevent autoimmune diseases will be a major challenge for the HLA field in the future. HLA will also be of increasing importance in pharmacogenomics, vaccinations and anthropology. Together, this will leave the HLA field with many new challenges and opportunities, which in the future will require more focus on functional aspects of the immunogenetics of HLA.

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“…Perhaps foremost among these are alloantigens introduced by tissue and organ transplantation. The presence or induction of alloantibodies is increasingly recognized as a major contributing factor to acute and chronic rejection, and clearly play direct roles in sensitization [103,104]. Similarly, gene and cell therapeutics involve long-term introduction of structural gene products, as well as the presence of delivery vectors [105,106] that may elicit alloantibody formation.…”

Section: Resolve Revise and Relax: The 3 Rs Of Repertoire Adjustmentioning

confidence: 99%

Resolve, revise, and relax: The 3 Rs of B cell repertoire adjustment

Scholz

Cancro

2012

Immunology Letters

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Competition for limited, cell extrinsic survival factors is a general feature of peripheral selection checkpoints involved in B lymphocyte maturation and activation. Perhaps the best-characterized example involves BLyS (B lymphocyte stimulator), which modulates the size and composition of mature naïve B cell pools, but evidence for analogous competitive checkpoints is emerging for both germinal center B cells and plasma cells. Here we discuss how deliberate alteration of BLyS levels might be used to manipulate B cell repertoire selection in order to restore self-tolerance in autoimmunity, remodel the repertoire to accommodate neo-self antigens introduced through transplantation and gene therapy, or expand repertoire diversity to reveal novel, therapeutically useful specificities.

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Current approaches to the management of highly sensitized kidney transplant patients

Cited by 21 publications

References 59 publications

Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

On the future of HLA

Resolve, revise, and relax: The 3 Rs of B cell repertoire adjustment

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