TY - CHAP
T1 - Posttransplant immunosuppression in highly sensitized patients
AU - Akalin, Enver
PY - 2009
Y1 - 2009
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=59849117803&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=59849117803&partnerID=8YFLogxK
U2 - 10.1159/000170810
DO - 10.1159/000170810
M3 - Chapter
C2 - 19001811
AN - SCOPUS:59849117803
SN - 9783805589451
T3 - Contributions to Nephrology
SP - 27
EP - 34
BT - Humoral Immunity in Kidney Transplantation
A2 - Remuzzi, Giuseppe
A2 - Perico, Norberto
A2 - Chiaramonte, Stefano
A2 - Ronco, Claudio
ER -