Sensitized Patients, Transplant, and Management

Sensitization to human leukocyte antigens (HLA) creates significant barriers for renal transplant candidates, reducing access to transplantation by limiting donor availability and increasing the risk of rejection. Sensitized patients also endure longer wait-times on dialysis. Desensitization protocols, kidney-paired donation, and a combination of both of these modalities have been used to remove or circumvent the clinically deleterious anti-HLA antibodies. Technical advances in antibody characterization methods and therapies targeting the humoral arm of the immune system have facilitated successful transplantation for these immunologically challenging patients. However, antibody-mediated rejection and transplant glomerulopathy resulting from injury to the vascular endothelium are major impediments to further improvement in outcomes. This review describes the assessment protocols, antibody monitoring techniques, and therapeutic strategies that have been used effectively to overcome HLA incompatibility.

Duke Scholars

Author Annette M Jackson Surgery, Abdominal Transplant Surgery