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Identification and Therapeutic Management of Highly Sensitized Patients Undergoing Renal Transplantation

  • Therapy In Practice
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Abstract

Sensitization is generally referred to as the development of alloantibodies, specifically anti-human leukocyte antigen (HLA) immunoglobulin G (IgG) antibodies, most commonly caused by pregnancy, blood transfusion or a previous transplant. Despite being a well known phenomenon, there has not been a general consensus on its definition, monitoring or management. Today, 25% of the patients waitlisted for kidney transplant in the US have a panel reactive antibody (PRA) of >10% while, in the Eurotransplant zone, 14% have a PRA of >5%. Sensitized patients have more difficulty in finding a well HLA-matched donor, and have a higher risk of experiencing longer waiting times, more rejection episodes and eventually inferior long-term graft or patient survival. We review the currently available strategies in identifying and managing highly sensitized patients undergoing renal transplantation. We discuss the progress and limitations in laboratory techniques to elaborate on challenges in defining sensitized patients. The main management options (i.e. the Acceptable Mismatch Program, donor exchange programmes and the desensitization approach) and their mechanisms, related policies, advantages and outcomes, as well as medications and methods being investigated, are updated. In addition, particular emphasis is given to sensitization prevention, a practice that is neglected with our increasing ability to suppress the immune system.

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No sources of funding were used to conduct this study or prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Lu Huber, Michael Dürr, Mareen Matz, Lutz Liefeldt, Hans-H. Neumayer &  Klemens Budde

  2. HLA Laboratory, Charité Universitätsmedizin Berlin, Berlin, Germany

    Nils Lachmann & Constanze Schönemann

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  1. Lu Huber
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  2. Nils Lachmann
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  3. Michael Dürr
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Correspondence to Klemens Budde.

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Huber, L., Lachmann, N., Dürr, M. et al. Identification and Therapeutic Management of Highly Sensitized Patients Undergoing Renal Transplantation. Drugs 72, 1335–1354 (2012). https://doi.org/10.2165/11631110-000000000-00000

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