Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients.

Journal Article (Journal Article;Review)

PURPOSE OF REVIEW: Many sensitized patients have willing live donors but are unable to use them because of a human leukocyte antigen (HLA) incompatibility. The options for these patients include: remaining on the deceased-donor list, entering a kidney-paired donation scheme, or undergoing desensitization with high-dose IVIg or plasmapheresis and low-dose IVIg. RECENT FINDINGS: Mathematical simulations verified by actual data from several national kidney-paired donation (KPD) programs has shed light on which donor/recipient phenotypes are likely to benefit from each transplant modality. Pairs that are easy to match are likely to receive compatible kidneys in a KPD. Those who are hard to match may be better served by desensitization. The phenotype which is both hard to match and hard to desensitize due to board and strong HLA reactivity are most likely to be transplanted by a hybrid modality utilizing desensitization after identifying a more immunologically favorable donor in a KPD. SUMMARY: Recent outcomes from desensitization in which starting donor-specific antibody strength is low have been very good. For broadly sensitized patients with a high-strength cross-match, searching for a better donor in a KPD pool can facilitate a safer, less expensive, and more successful desensitization treatment course.

Full Text

Duke Authors

Cited Authors

  • Montgomery, RA; Lonze, BE; Jackson, AM

Published Date

  • August 2011

Published In

Volume / Issue

  • 16 / 4

Start / End Page

  • 439 - 443

PubMed ID

  • 21666478

Electronic International Standard Serial Number (EISSN)

  • 1531-7013

Digital Object Identifier (DOI)

  • 10.1097/MOT.0b013e32834897c1


  • eng

Conference Location

  • United States