Desensitization protocols improving access and outcome in transplantation

Montgomery, Robert A.; Leffell, Mary S.

doi:10.1016/j.cair.2005.10.002

Cited by 9 publications

(3 citation statements)

References 98 publications

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“…These protocols, developed to desensitize patients in preparation for TX, are currently being used to treat AMR [9,34]. PP, one PV exchange replaced with albumin or FFP, should be performed every other day followed by a low-dose (100 mg/kg) CMV Ig infusion until DSA is eliminated.…”

Section: Treatment Protocolsmentioning

confidence: 99%

Plasma Exchange and Immunoadsorption of Patients with Thoracic Organ Transplantation

Rummler

Barz²

2012

Transfus Med Hemother

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Primary organ failure after transplantation (TX) remains a serious complication and leads to a high percentage of lethality. It is known, however, that the speed of rejection and tissue destruction depends on 3 main factors: antibody titer, the ability of the tissue to repair itself, and immunosuppressive measures. Especially with evidence for antibodies against human leukocyte antigen (HLA-ab), the immunological risk of persistent and acute episodes of rejection increases. The role of non-HLA-ab in rejection episodes is often underestimated and should be studied further. Antibody-mediated rejection (AMR) is still an unsolved problem in thoracic organ TX. An essential pillar of antihumoral therapy are the extracorporeal procedures like plasmapheresis (PP), therapeutic plasma exchange (TPE), and immunoadsorption (IA), because only they have the ability to remove preformed or de novo developed antibodies quickly and effectively. The quick removal of antibodies and other plasma factors through TPE or IA remains an effective and supportive method for treating AMR and allows the TX despite preformed antibodies. The pertinent literature does not disclose, however, how often and for how long treatment should be administered. It is known, that repeated treatment cycles with adequately processed plasma volume must be used to overcome redistribution of pathological antibodies. Based on our experience in heart transplant recipients with compromised graft function due to non-HLA-ab and HLA-ab, IA seems to be more effective.

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Section: Treatment Protocolsmentioning

confidence: 99%

Plasma Exchange and Immunoadsorption of Patients with Thoracic Organ Transplantation

Rummler

Barz²

2012

Transfus Med Hemother

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“…However, antibody rebound occurs unless the treatments are combined with antibody-suppressing drugs. These procedures have also been used to treat AMR and a review of the results obtained with these various protocols can be found in (21).…”

Section: Plasmapheresismentioning

confidence: 99%

Desensitization: achieving immune detente

Eng¹

2010

Tissue Antigens

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Antibodies to donor HLA (human leukocyte antigen) and/or ABO antigens were a contraindication to transplantation of most organs for decades. Desensitization protocols have shown the ability to produce reduction of such antibodies sufficient to achieve a successful transplantation. The two major protocols in use are high-dose IVIg or plasmapheresis with low-dose IVIg. The protocols differ in the basic treatment and, to some degree, in their application, but both use standard immunosuppressive agents as well as more recently developed adjunctive agents such as cell-depleting antibodies. Graft and patient survival with both types of protocol are comparable to that of non-sensitized patients, although desensitized patients do have a higher incidence of antibody-mediated rejection (AMR). Antibodies to donor antigens may persist after transplantation, and while the initial antibody titer represents the level of difficulty for successful desensitization, the strength of antibodies that persist after transplantation reflects the risk of AMR. Current protocols do not eliminate B cell clones specific for donor HLA; therefore, desensitized patients remain at an increased risk of antibody rebound if patients experience pro-inflammatory events. Therefore, ongoing antibody monitoring is crucial for early detection of antibody-mediated graft injury. Importantly, the results of numerous programs show that ABOi- and HLA-positive crossmatch renal transplantation, with proper desensitization, can be performed successfully. Further, in addition to increasing the rate of transplantation among sensitized patients, desensitization is providing insight into immunoregulatory processes and may provide information useful in diseases involving immune dysfunction.

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“…Sensitized patients wait longer for a transplant and, once transplanted, experience more rejection episodes and have decreased graft survival compared to non-sensitized recipients (5)(6)(7)(8). Improvements in HLA-specific antibody detection have expanded the donor pool available to sensitized patients (9)(10)(11)(12)(13)(14) and desensitization protocols designed to reduce the breadth and amount of HLA-specific antibody have found increased success during the last decade (15)(16)(17)(18)(19)(20). Determining the appropriate course of treatment for the sensitized patient requires accurate immunologic characterization and clinical assessment of the patient.…”

Section: Introductionmentioning

confidence: 99%

The problem of transplanting the sensitized patient: whose problem is it?

Jackson

2008

Front Biosci

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Transplantation is the treatment of choice for end-stage renal failure and a life-saving treatment for failure of other major organs. Improvements in surgical techniques, histocompatibility testing, and immunosuppressive drugs have significantly improved both patient and graft survival. However, there are formidable barriers to the successful transplantation of patients who possess HLA-specific antibodies. Sensitized patients wait longer for a transplant and, once transplanted, experience more rejection episodes and have decreased graft survival compared to non-sensitized recipients. Improvements in HLA-specific antibody detection have expanded the donor pool available to sensitized patients and desensitization protocols designed to reduce the breadth and amount of HLA-specific antibody have found increased success during the last decade. Determining the appropriate course of treatment for the sensitized patient requires accurate immunologic characterization and clinical assessment of the patient. Together, the transplant physician and histocompatibility expert must determine what constitutes a compatible donor and assess the patient's risk for a particular transplant. Thus, sensitization to HLA antigens is a problem for the patient, the transplant physician, and the histocompatibility laboratory.

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Desensitization protocols improving access and outcome in transplantation

Cited by 9 publications

References 98 publications

Plasma Exchange and Immunoadsorption of Patients with Thoracic Organ Transplantation

Plasma Exchange and Immunoadsorption of Patients with Thoracic Organ Transplantation

Desensitization: achieving immune detente

The problem of transplanting the sensitized patient: whose problem is it?

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