Posttransplant immunosuppression in highly sensitized patients

Research output: Chapter in Book/Report/Conference proceedingChapter

10 Scopus citations

Abstract

Recent desensitization protocols using the combination of plasmapheresis (PP) or immunoadsorption to remove donor-specific anti-HLA antibodies (DSA) and/or intravenous immunoglobulin (IVIG) and rituximab to downregulate antibody-mediated immune responses have made kidney transplantation feasible by abrogating cross-match positivity. Despite good short-term patient and graft survival, acute antibody-mediated rejection (AMR) continued to be an important barrier seen in 20-30% of patients receiving desensitization pro-tocols and it is still not clear which protocol (high-dose IVIG, PP/low-dose IVIG), what type of induction treatment (thymoglobulin, anti-IL-2R antibodies, alemtuzumab), or addition of rituximab is better for the prevention of early acute AMR. Future prospective, multicenter, and randomized trials are required to decide the ideal protocol for sensitized patients.

Original languageEnglish (US)
Title of host publicationHumoral Immunity in Kidney Transplantation
Subtitle of host publicationWhat Clinicians Need to Know
EditorsGiuseppe Remuzzi, Norberto Perico, Stefano Chiaramonte, Claudio Ronco
Pages27-34
Number of pages8
DOIs
StatePublished - Jul 31 2009
Externally publishedYes

Publication series

NameContributions to Nephrology
Volume162
ISSN (Print)0302-5144

ASJC Scopus subject areas

  • Nephrology

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    Akalin, E. (2009). Posttransplant immunosuppression in highly sensitized patients. In G. Remuzzi, N. Perico, S. Chiaramonte, & C. Ronco (Eds.), Humoral Immunity in Kidney Transplantation: What Clinicians Need to Know (pp. 27-34). (Contributions to Nephrology; Vol. 162). https://doi.org/10.1159/000170810