دورية أكاديمية
أعرض في EDS

Advances in desensitization for human leukocyte antigen incompatible kidney transplantation.

التفاصيل البيبلوغرافية
العنوان: Advances in desensitization for human leukocyte antigen incompatible kidney transplantation.
المؤلفون: Vo A; Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California, USA., Ammerman N, Jordan SC
المصدر: Current opinion in organ transplantation [Curr Opin Organ Transplant] 2024 Apr 01; Vol. 29 (2), pp. 104-120. Date of Electronic Publication: 2023 Dec 13.
نوع المنشور: Review; Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9717388 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-7013 (Electronic) Linking ISSN: 10872418 NLM ISO Abbreviation: Curr Opin Organ Transplant Subsets: MEDLINE
أسماء مطبوعة: Publication: <2003->: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Philadelphia, PA : Rapid Science Publishers,
مواضيع طبية MeSH: Kidney Transplantation*/adverse effects, Infant, Newborn ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Graft Rejection/prevention & control ; Immunosuppressive Agents/adverse effects ; Antibodies ; HLA Antigens ; Desensitization, Immunologic
مستخلص: Purpose of Review: Human leukocyte antigen (HLA) sensitization is a major barrier to kidney transplantation induced by exposure to alloantigens through pregnancy, blood product exposure and previous transplantations. Desensitization strategies are undertaken to improve the chances of finding compatible organ offers. Standard approaches to desensitization include the use of plasmapheresis/low dose intravenous immunoglobulin (IVIG) or high dose IVIG plus anti-CD20. However, current methods to reduce HLA antibodies are not always successful, especially in those with calculated panel reactive antibody 99-100%.
Recent Findings: Newer desensitization strategies such as imlifidase [immunoglobulin G (IgG) endopeptidase] rapidly inactivates IgG molecules and creates an "antibody-free zone", representing an important advancement in desensitization. However, pathogenic antibodies rebound, increasing allograft injury that is not addressed by imlifidase. Here, use of anti-IL-6R (tocilizumab) or anti-interleukin-6 (clazakizumab) could offer long-term control of B-memory and plasma cell DSA responses to limit graft injury. Agents aimed at long-lived plasma cells (anti-CD38 and anti-BCMAxCD3) could reduce or eliminate HLA-producing plasma cells from marrow niches. Other agents such as complement inhibitors and novel agents inhibiting the Fc neonatal receptor (FcRn) mediated IgG recycling will likely find important roles in desensitization.
Summary: Use of these agents alone or in combination will likely improve the efficacy and durability of desensitization therapies, improving access to kidney transplantation for immunologically disadvantaged patients.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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المشرفين على المادة: 0 (Immunoglobulins, Intravenous)
0 (Immunosuppressive Agents)
0 (Antibodies)
0 (HLA Antigens)
تواريخ الأحداث: Date Created: 20231213 Date Completed: 20240308 Latest Revision: 20240604
رمز التحديث: 20240604
DOI: 10.1097/MOT.0000000000001131
PMID: 38088373
قاعدة البيانات: MEDLINE
الوصف
تدمد:1531-7013
DOI:10.1097/MOT.0000000000001131