Desensitization protocols and their outcome

Kwaku Marfo, Amy Lu, Min Ling, Enver Akalin

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

In the last decade, transplantation across previously incompatible barriers has increasingly become popular because of organ donor shortage, availability of better methods of detecting and characterizing anti-HLA antibodies, ease of diagnosis, better understanding of antibody-mediated rejection, and the availability of effective regimens. This review summarizes all manuscripts published since the first publication in 2000 on desensitized patients and discusses clinical outcomes including acute and chronic antibody-mediated rejection rate, the new agents available, kidney paired exchange programs, and the future directions in sensitized patients. There were 21 studies published between 2000 and 2010, involving 725 patients with donor-specific anti-HLA antibodies (DSAs) who underwent kidney transplantation with different desensitization protocols. All studies were single center and retrospective. The patient and graft survival were 95% and 86%, respectively, at a 2-year median follow-up. Despite acceptable short-term patient and graft survivals, acute rejection rate was 36% and acute antibody-mediated rejection rate was 28%, which is significantly higher than in nonsen-sitized patients. Recent studies with longer follow-up of those patients raised concerns about long-term success of desensitization protocols. The studies utilizing protocol biopsies in desensitized patients also reported higher subclinical and chronic antibody-mediated rejection. An association between the strength of DSAs determined by median fluorescence intensity values of Luminex single-antigen beads and risk of rejection was observed. Two new agents, bortezomib, a proteasome inhibitor, and eculizumab, an anti-complement C5 antibody, were recently introduced to desensitization protocols. An alternative intervention is kidney paired exchange, which should be considered first for sensitized patients.

Original languageEnglish (US)
Pages (from-to)922-936
Number of pages15
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number4
DOIs
StatePublished - Apr 1 2011

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Antibodies
Anti-Idiotypic Antibodies
Tissue Donors
Graft Survival
Complement C5
Kidney
Proteasome Inhibitors
Manuscripts
Kidney Transplantation
Publications
Transplantation
Fluorescence
Biopsy
Antigens
Direction compound
Bortezomib
eculizumab

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Desensitization protocols and their outcome. / Marfo, Kwaku; Lu, Amy; Ling, Min; Akalin, Enver.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 4, 01.04.2011, p. 922-936.

Research output: Contribution to journalArticle

Marfo, Kwaku ; Lu, Amy ; Ling, Min ; Akalin, Enver. / Desensitization protocols and their outcome. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 4. pp. 922-936.
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