Desensitization for solid organ and hematopoietic stem cell transplantation
| Autor: | Andrea A. Zachary, Mary S. Leffell |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Graft Rejection
medicine.medical_specialty medicine.medical_treatment Immunology desensitization Hematopoietic stem cell transplantation Human leukocyte antigen Biology Organ transplantation donor-specific antibodies HLA Antigens Isoantibodies intravenous immunoglobulin medicine Animals Humans Immunology and Allergy Invited Reviews solid organ transplantation Kidney transplantation Desensitization (medicine) Graft Survival Hematopoietic Stem Cell Transplantation Organ Transplantation medicine.disease Histocompatibility Transplantation Treatment Outcome plasmapheresis Desensitization Immunologic Transplantation Tolerance Stem cell |
| Zdroj: | Immunological Reviews |
| ISSN: | 1600-065X 0105-2896 |
| DOI: | 10.1111/imr.12150 |
| Popis: | Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft. |
| Databáze: | OpenAIRE |
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