Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums

Gebel, Howard M.; Moussa, Omar; Eckels, David D.; Bray, Robert A.

doi:10.1016/j.humimm.2009.04.012

Cited by 34 publications

(19 citation statements)

References 57 publications

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“…Graft survival rates in high-risk sensitized patients with HLA antibodies from previous transplantation, transfusion, or pregnancy are inferior to that in unsensitized recipients partly because of antibodymediated rejection (AMR) resulting from undetected or de novo donor-specific HLA antibodies [1,2]. Currently, 34.4% of patients in the waiting list in the United States are sensitized to HLAs, and 14.4% have a peak percentage of panel-reactive antibody (PRA) greater than 80%.…”

Section: Introductionmentioning

confidence: 99%

Successful kidney transplantation in highly sensitized patients

et al. 2011

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Highly sensitized patients experience an increased number of rejection episodes and have poorer graft survival rates; hence, sensitization is a significant barrier to both access to and the success of organ transplantation. This study reports our experience in kidney transplantation in highly sensitized patients. Fourteen patients with sensitization or high levels of panelreactive antibodies (PRA) were studied. All patients were desensitized with pre-transplant intravenous immunoglobulin (IVIG)/plasmapheresis (PP) with or without rituximab and thymoglobulin induction therapy, combined with a Prograf/MMF/Pred immunosuppressive regimen. Of 14 patients, 10 showed good graft functions without acute rejection (AR) episodes. Acute cellular rejection in two patients was reversed by methylprednisolone. Two patients underwent antibody-mediated rejection; one was treated with PP/IVIG successfully, whereas the other lost graft functions due to the de novo production of donor-specific antibodies (DSA). Graft functions were stable, and there were no AR episodes in other patients. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful live-donor kidney transplantation in sensitized recipients.

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Section: Introductionmentioning

confidence: 99%

Successful kidney transplantation in highly sensitized patients

et al. 2011

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“…It is only after such complete analysis that the relevance of non-ARS mismatches can be determined. Although high-resolution typing has been traditionally used for bone marrow transplantation, disease association studies, and population genetics, recent observations indicate that high-resolution typing may also be important in solid organ transplantation where allele specific antibody has been observed [27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Next-generation sequencing: the solution for high-resolution, unambiguous human leukocyte antigen typing

Lind¹,

Ferriola²,

Mackiewicz³

et al. 2010

Human Immunology

135

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“…The Luminex assay is now taken as the reference technique for DSA testing [17]. It uses tiny polystyrene beads containing fluorochromes of different intensity with HLA antigen(s) immobilized on their surfaces.…”

Section: Luminex Single-antigen Bead (L-sab)mentioning

confidence: 99%

Crossmatching in Renal Transplantation by Non-Immunologists for Non-Immunologists

Sharma¹

2017

UNOAJ

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Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums

Cited by 34 publications

References 57 publications

Successful kidney transplantation in highly sensitized patients

Successful kidney transplantation in highly sensitized patients

Next-generation sequencing: the solution for high-resolution, unambiguous human leukocyte antigen typing

Crossmatching in Renal Transplantation by Non-Immunologists for Non-Immunologists

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