Johns Hopkins Medical Institutions, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Transplant. 2010 Mar;10(3):449-57. doi: 10.1111/j.1600-6143.2009.03001.x. Epub 2010 Feb 1.
The field of desensitization and incompatible transplantation has made great gains over the past decade. There are now several options and effective therapies for many patients who face antibody barriers. Kidney paired donation (KPD) and desensitization have traditionally been considered competing strategies and patients have been offered one or the other without regard for the probability of a successful outcome. It is now possible to predict which donor/recipient phenotypes will benefit from each of these modalities. KPD should be favored among patients with immunologic phenotypes that are likely to match without prolonged waiting times. However, as many as 50% of patients with incompatible donors will fail to find a match in a KPD pool and many of these patients could be desensitized to their donor. Positive crossmatch and ABO incompatible transplantation has been accomplished in selective cases without the need for heavy immunosuppression or B-cell ablative therapy. Patients who are both difficult-to-match due to broad sensitization and hard-to-desensitize because of strong donor reactivity can often be successfully transplanted through a combination of desensitization and KPD. Using these various modalities it is estimated that most patients with incompatible live donors can undergo successful renal transplantation.
在过去的十年中，脱敏和不相容移植领域取得了重大进展。现在，许多面临抗体障碍的患者都有几种选择和有效的治疗方法。肾配对捐赠（KPD）和脱敏传统上被认为是相互竞争的策略，患者在不考虑成功几率的情况下，只被提供其中一种选择。现在可以预测哪些供体/受者表型将从这些方式中受益。在免疫表型不太可能匹配但等待时间不长的患者中，应该优先考虑 KPD。然而，多达 50%的不相容供体患者将无法在 KPD 池中找到匹配者，而这些患者中的许多人可以对其供体进行脱敏。在不需要大量免疫抑制或 B 细胞清除治疗的情况下，在某些选择性病例中已经成功完成了阳性交叉配型和 ABO 不相容移植。由于广泛致敏而难以匹配且由于强烈的供体反应而难以脱敏的患者，通常可以通过脱敏和 KPD 的组合成功移植。使用这些各种方式，估计大多数具有不相容活体供体的患者都可以进行成功的肾移植。
