PURPOSE OF REVIEW: Many sensitized patients have willing live donors but are unable to use them because of a human leukocyte antigen (HLA) incompatibility. The options for these patients include: remaining on the deceased-donor list, entering a kidney-paired donation scheme, or undergoing desensitization with high-dose IVIg or plasmapheresis and low-dose IVIg. RECENT FINDINGS: Mathematical simulations verified by actual data from several national kidney-paired donation (KPD) programs has shed light on which donor/recipient phenotypes are likely to benefit from each transplant modality. Pairs that are easy to match are likely to receive compatible kidneys in a KPD. Those who are hard to match may be better served by desensitization. The phenotype which is both hard to match and hard to desensitize due to board and strong HLA reactivity are most likely to be transplanted by a hybrid modality utilizing desensitization after identifying a more immunologically favorable donor in a KPD. SUMMARY: Recent outcomes from desensitization in which starting donor-specific antibody strength is low have been very good. For broadly sensitized patients with a high-strength cross-match, searching for a better donor in a KPD pool can facilitate a safer, less expensive, and more successful desensitization treatment course.
PURPOSE OF REVIEW: Many sensitized patients have willing live donors but are unable to use them because of a human leukocyte antigen (HLA) incompatibility. The options for these patients include: remaining on the deceased-donor list, entering a kidney-paired donation scheme, or undergoing desensitization with high-dose IVIg or plasmapheresis and low-dose IVIg. RECENT FINDINGS: Mathematical simulations verified by actual data from several national kidney-paired donation (KPD) programs has shed light on which donor/recipient phenotypes are likely to benefit from each transplant modality. Pairs that are easy to match are likely to receive compatible kidneys in a KPD. Those who are hard to match may be better served by desensitization. The phenotype which is both hard to match and hard to desensitize due to board and strong HLA reactivity are most likely to be transplanted by a hybrid modality utilizing desensitization after identifying a more immunologically favorable donor in a KPD. SUMMARY: Recent outcomes from desensitization in which starting donor-specific antibody strength is low have been very good. For broadly sensitized patients with a high-strength cross-match, searching for a better donor in a KPD pool can facilitate a safer, less expensive, and more successful desensitization treatment course.
Authors: Babak J Orandi; Xun Luo; Allan B Massie; Jacqueline M Garonzik-Wang; Bonne E Lonze; Rizwan Ahmed; Kyle J Van Arendonk; Mark D Stegall; Stanley C Jordan; Jose Oberholzer; Ty B Dunn; Lloyd E Ratner; Sandip Kapur; Ronald P Pelletier; John P Roberts; Marc L Melcher; Pooja Singh; Debra L Sudan; Marc P Posner; Jose M El-Amm; Ron Shapiro; Matthew Cooper; George S Lipkowitz; Michael A Rees; Christopher L Marsh; Bashir R Sankari; David A Gerber; Paul W Nelson; Jason Wellen; Adel Bozorgzadeh; A Osama Gaber; Robert A Montgomery; Dorry L Segev Journal: N Engl J Med Date: 2016-03-10 Impact factor: 91.245
Authors: Stuart M Flechner; Alvin G Thomas; Matthew Ronin; Jeffrey L Veale; David B Leeser; Sandip Kapur; John D Peipert; Dorry L Segev; Macey L Henderson; Ashton A Shaffer; Matthew Cooper; Garet Hil; Amy D Waterman Journal: Am J Transplant Date: 2018-04-30 Impact factor: 8.086
Authors: Howard M Gebel; Bertram L Kasiske; Sally K Gustafson; Joshua Pyke; Eugene Shteyn; Ajay K Israni; Robert A Bray; Jon J Snyder; John J Friedewald; Dorry L Segev Journal: Clin J Am Soc Nephrol Date: 2016-02-02 Impact factor: 8.237
Authors: Kyle R Jackson; Jennifer D Motter; Amber Kernodle; Niraj Desai; Alvin G Thomas; Allan B Massie; Jacqueline M Garonzik-Wang; Dorry L Segev Journal: Am J Transplant Date: 2020-03-12 Impact factor: 8.086