Journal
CURRENT OPINION IN ORGAN TRANSPLANTATION
Volume 17, Issue 4, Pages 416-422Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOT.0b013e328355f1ab
Keywords
C1q reactivity; desensitization; donor-specific HLA antibodies; thoracic transplantation
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Funding
- Thomas E Starzl Transplantation Institute
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Purpose of review Desensitization therapies in sensitized patients have been implemented to lower the human leukocyte antigen (HLA) antibody burden and facilitate thoracic transplantation. This review will focus on the characterization of HLA antibodies pre- and post-intervention, to assess the changes in antibody titer and function that might promote transplantation with low risk of early antibody-mediated rejection (AMR). Recent findings A steady increase in the proportion of both adult and pediatric sensitized thoracic patients awaiting transplantation has been observed over the last years. Patients with elevated panel reactive antibodies at the time of listing have a poorer outcome compared to nonsensitized patients. Advances in solid phase assays for HLA antibodies have benefited the detection accuracy and characterization of clinically relevant anti-HLA antibodies. Therefore, monitoring the level and function of HLA antibodies following desensitization protocols can be used to determine the success of achieving acceptable antibody levels for safe transplantation and also the risk of AMR. Summary Allosensitization among candidates considered for thoracic transplantation remains a great challenge. Determining the efficacy of desensitizing protocols by incorporating new tools for monitoring antibody profiles can better stratify a candidate's immunologic risk, thereby increasing the likelihood of transplantation and minimizing AMR.
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