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Rationalizing Incompatible Living Donor Kidney Transplantation for Highly Sensitized Candidates

  • Live Kidney Donation (KL Lentine and R Schaffer, Section Editors)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Because highly sensitized kidney transplant candidates must draw from a large donor pool to find a biologically compatible donor, living donor transplantation is uncommon among HLA-sensitized patients in need of kidney transplantations. We review current data on treatment options for highly sensitized kidney transplant candidates and provide recommendations based on the evidence and our clinical experience.

Recent Findings

As kidney paired donation becomes more common in the USA, recent studies have published outcomes from large, multi-center national exchange programs. Recent national studies have also provided data on experience with HLA-incompatible kidney transplantation options for the highly sensitized candidate including paired kidney exchange, desensitization with HLA-incompatible transplantation, or waiting for a deceased donor transplant. This review summarizes the pros and cons of these options and provides recommendations for the highly sensitized patient with an incompatible living donor. Considerations include the likelihood of finding a biologically compatible donor, the degree of HLA-incompatibility and their associated outcomes in comparison to compatible transplantation, the downside of remaining on dialysis while waiting for a more suitable donor, and patient preference.

Summary

Given the challenges in finding biologically compatible donors, HLA-incompatible transplantation is an appropriate option for many highly sensitized kidney transplant candidates.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, Transplant Immunotherapy Program, Cedars-Sinai Medical Center, 8900 Beverly Blvd, Los Angeles, CA, 90048, USA

    Edmund Huang & Stanley C. Jordan

Authors
  1. Edmund Huang
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  2. Stanley C. Jordan
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Correspondence to Edmund Huang.

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Conflict of Interest

Dr. Huang has received research grants and consulting fees from CareDx, Inc. and Veloxis Pharmaceuticals. He has also received a research grant from CSL-Behring. Dr. Jordan has received research grants and consulting fees from CSL Behring, Amplyx, and Hansa Biopharma. He also has a patent pending for use of interleukin-6 monoclonal antibodies for desensitization and treatment of antibody-mediated rejection.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Huang, E., Jordan, S.C. Rationalizing Incompatible Living Donor Kidney Transplantation for Highly Sensitized Candidates. Curr Transpl Rep 8, 250–255 (2021). https://doi.org/10.1007/s40472-021-00329-y

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  • DOI: https://doi.org/10.1007/s40472-021-00329-y

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