Immunoglobulin G–Degrading Enzyme of Streptococcus pyogenes (IdeS), Desensitization, and the Kidney Allocation System

Huang, Edmund; Jordan, Stanley C.

doi:10.2215/cjn.12031017

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…This endopeptidase rapidly cleaves all IgG into F(ab’) and Fc fragments to impair the effector function from all circulating IgG. In both phase 1 and 2 desensitization trials, this agent led to a precipitous drop in DSA within hours, and therefore is a valuable tool for deceased donor positive crossmatch transplantation to avoid hyperacute rejection ( 44 , 52 ). The main limitation is that this drug will likely need to be part of a combination therapy regimen because it only cleaves circulating antibody and antibody levels begin to have a brisk rebound within 3-7 days ( 44 , 52 ).…”

Section: Emerging Therapeutics For Desensitizationmentioning

confidence: 99%

Current Approaches to Desensitization in Solid Organ Transplantation

2021

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Major advancements in the development of HLA antibody detection techniques and our understanding of the outcomes of solid organ transplant in the context of HLA antibody have occurred since the relevance of sensitization was first recognized nearly 50 years ago. Additionally, kidney paired donation programs (KPD) have become widespread, deceased donor allocation policies have changed, and several new therapeutic options have become available with promise to reduce HLA antibody. In this overview we aim to provide thoughtful guidance about when desensitization in kidney transplantation should be considered taking into account the outcomes of HLA incompatible transplantation. Novel therapeutics, desensitization endpoints, and strategies for future study will also be discussed. While most of our understanding about desensitization comes from studying kidney transplant candidates and recipients, many of the concepts discussed can be easily applied to desensitization in all of solid organ transplantation.

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Section: Emerging Therapeutics For Desensitizationmentioning

confidence: 99%

Current Approaches to Desensitization in Solid Organ Transplantation

2021

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“…After desensitization with plasmapheresis and rituximab the FXCM positive group showed a higher rate of surgical complications-including hematoma (3.7% vs. 20.0%, P < 0.001), bleeding requiring operation (1.0% vs. 6.7%, P = 0.002), and lymphocele (2.7% vs. 8.9%, P = 0.020)than the FXCM negative group. Infectious complications, however, demonstrated no significant differences [66].…”

Section: Bleedingmentioning

confidence: 87%

“…A subsequent multicenter, multinational, phase 2 trial of IgG endopeptidase for desensitization [66] is currently ongoing (NCT02790437). The immediate effect of IgG endopeptidase on donorspecific antibodies in the preliminary study was profound, with near or complete reduction of HLA antibodies at 6 h. Suppression of HLA antibodies was durable among patients treated with intravenous immunoglobulin and rituximab in the United States.…”

Section: Complication From Igg Endopeptidase (Ides)mentioning

confidence: 99%