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The role of therapeutic apheresis in high immunologic risk renal transplantation: a review of current trends.

Publication ,  Journal Article
Sanoff, SL; Balogun, RA; Lobo, PL
Published in: Semin Dial
2012

Immunologic sensitization, defined by the presence of antibodies directed against donor human leukocyte antigen (or so called donor-specific antibodies [DSA]), is common among those awaiting kidney transplantation, and is associated with worse outcomes following transplant. Existing DSA have historically been screened for pretransplant using complement-dependent cytotoxic crossmatching and their risk circumnavigated through policies that prohibit transplants between incompatible donor-recipient pairs. This risk avoidance strategy maximizes outcomes following transplant, but at the expense of limiting access to transplant for sensitized individuals. Over the last decade, the field of kidney transplantation has moved to actively modify the risks posed by DSA, rather than to simply avoid them. More sensitive detection methods have provided detailed immunologic risk stratification of potential donor-recipient pairs. Desensitization protocols, in which therapeutic aphaeresis plays a central role, have been used to reduce the potential harms posed by DSA. More recently, desensitization and paired donor exchange programs have been used in combination to expand transplantation to highly sensitized patients with incompatible living donors. It is likely that this combination of risk mitigation and avoidance strategies will be used together more often to both maximize individuals' access to transplant, and optimize patient and graft outcomes.

Duke Scholars

Published In

Semin Dial

DOI

EISSN

1525-139X

Publication Date

2012

Volume

25

Issue

2

Start / End Page

193 / 200

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Transplantation Immunology
  • Tissue Donors
  • Risk Assessment
  • Prognosis
  • Preoperative Care
  • Postoperative Care
  • Male
  • Kidney Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sanoff, S. L., Balogun, R. A., & Lobo, P. L. (2012). The role of therapeutic apheresis in high immunologic risk renal transplantation: a review of current trends. Semin Dial, 25(2), 193–200. https://doi.org/10.1111/j.1525-139X.2011.01032.x
Sanoff, Scott L., Rasheed A. Balogun, and Peter L. Lobo. “The role of therapeutic apheresis in high immunologic risk renal transplantation: a review of current trends.Semin Dial 25, no. 2 (2012): 193–200. https://doi.org/10.1111/j.1525-139X.2011.01032.x.
Sanoff, Scott L., et al. “The role of therapeutic apheresis in high immunologic risk renal transplantation: a review of current trends.Semin Dial, vol. 25, no. 2, 2012, pp. 193–200. Pubmed, doi:10.1111/j.1525-139X.2011.01032.x.
Journal cover image

Published In

Semin Dial

DOI

EISSN

1525-139X

Publication Date

2012

Volume

25

Issue

2

Start / End Page

193 / 200

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Transplantation Immunology
  • Tissue Donors
  • Risk Assessment
  • Prognosis
  • Preoperative Care
  • Postoperative Care
  • Male
  • Kidney Transplantation