Diagnostic value of specifi c anty-HLA alloantibodies before and after renal transplantation. Programs for highly sensitized recipients
Journal Title: Advances in Hygiene and Experimental Medicine - Year 2009, Vol 63, Issue
Abstract
Anti-HLA alloantibodies are the main barrier in kidney transplantation. Lack of appropriate donors for highly sensitized (HS) recipients makes access to transplantation very diffi cult and results in a signifi cant increase in both the time on the waiting list and the number of post-transplant complications in these patients. The transplantation itself is also associated with higher risk in the HS. There are many programs aimed at increasing access to renal transplantation for this group of recipients. It is noteworthy that new acceptable HLA-mismatches allowed significant progress in programs for HS recipients. Currently implemented programs (ET-AMP, UNOS, Emory algorithm) proved useful as they increased access to transplantation and graft survival in HS patients. Nevertheless, even with these programs there is still the problem of humoral rejection in these patients. The strong correlation between donor-specifi c antibodies (DSA) and graft rejection seen both immediately after transplantation and in long-term complications such as CAN (chronic allograft nephropathy) may be the simplest explanation for this effect. Hence the assessment of alloantibodies limited to the pre-transplant period, which is nowadays routine, seems insuffi cient. Current evidence suggests that early detection of post-transplant DSA may be an excellent prognostic marker of graft function and may allow implementing the necessary treatment prior to rejection.
Authors and Affiliations
Hanna Zielińska, Maciej Zieliński, Grażyna Moszkowska, Alicja Dębska-Ślizień, Magdalena Jankowska, Bolesław Rutkowski, Piotr Trzonkowski
Keywords
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