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

Publication ,  Journal Article
Montgomery, RA; Lonze, BE; Jackson, AM
Published in: Curr Opin Organ Transplant
August 2011

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.

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Published In

Curr Opin Organ Transplant

DOI

EISSN

1531-7013

Publication Date

August 2011

Volume

16

Issue

4

Start / End Page

439 / 443

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transplantation Tolerance
  • Surgery
  • Plasmapheresis
  • Living Donors
  • Kidney Transplantation
  • Isoantibodies
  • Immunoglobulins, Intravenous
  • Humans
  • Histocompatibility
 

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Montgomery, R. A., Lonze, B. E., & Jackson, A. M. (2011). Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients. Curr Opin Organ Transplant, 16(4), 439–443. https://doi.org/10.1097/MOT.0b013e32834897c1
Montgomery, Robert A., Bonnie E. Lonze, and Annette M. Jackson. “Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients.Curr Opin Organ Transplant 16, no. 4 (August 2011): 439–43. https://doi.org/10.1097/MOT.0b013e32834897c1.
Montgomery RA, Lonze BE, Jackson AM. Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients. Curr Opin Organ Transplant. 2011 Aug;16(4):439–43.
Montgomery, Robert A., et al. “Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients.Curr Opin Organ Transplant, vol. 16, no. 4, Aug. 2011, pp. 439–43. Pubmed, doi:10.1097/MOT.0b013e32834897c1.
Montgomery RA, Lonze BE, Jackson AM. Using donor exchange paradigms with desensitization to enhance transplant rates among highly sensitized patients. Curr Opin Organ Transplant. 2011 Aug;16(4):439–443.

Published In

Curr Opin Organ Transplant

DOI

EISSN

1531-7013

Publication Date

August 2011

Volume

16

Issue

4

Start / End Page

439 / 443

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transplantation Tolerance
  • Surgery
  • Plasmapheresis
  • Living Donors
  • Kidney Transplantation
  • Isoantibodies
  • Immunoglobulins, Intravenous
  • Humans
  • Histocompatibility