Overcoming the Hurdle: HLA Mismatch and Desensitization Therapy in Kidney Transplantation

Abstract

The success of kidney transplantation hinges on compatibility between donor and recipient. However, a major obstacle lies in the presence of Human Leukocyte Antigen (HLA) mismatches. These protein markers on cell surfaces trigger the recipient’s immune system to attack the transplanted kidney. This challenge is particularly prevalent in patients who have developed antibodies against mismatched HLA antigens due to prior transplants, blood transfusions, or pregnancies. This chapter delves into the complexities of HLA mismatch and its impact on kidney transplant outcomes. We explore the immunological basis for rejection and discuss the limitations of traditional matching strategies. Desensitization therapy emerges as a beacon of hope, offering a range of techniques to reduce pre-existing anti-HLA antibodies and improve transplant success rates. We deepen into the mechanisms of desensitization, exploring various approaches like plasma exchange, immunoadsorption, and B-cell depletion therapies; we mention the most common side effects of these treatments; and the chapter concludes by examining the current state of desensitization protocols and their potential to revolutionize kidney transplantation for a broader range of patients.