Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Curr Opin Organ Transplant. 2012 Aug;17(4):386-92. doi: 10.1097/MOT.0b013e328356132b.
Human leukocyte antigen (HLA) sensitization is a major public health problem that limits access to renal transplantation for 30% of the patients awaiting a kidney transplant. This review describes the transplantation modalities available to the sensitized patient and discusses aspects of the donor/recipient phenotypes that determine the most suitable option for a particular patient.
Patients, who undergo desensitization have a significant survival benefit compared with similar patients, who either remain on dialysis or wait for a compatible donor. The initial donor-specific antibody (DSA) strength is the best predictor of outcome and cost of desensitization. In small, uncontrolled single center trials, complement inhibitors, proteasome inhibitors and anti-CD20 have been used to both prevent and reverse antibody-mediated rejection (AMR).
With new agents being introduced into the armamentarium, which have not undergone rigorous investigation, it is important to emphasize that plasmapheresis, intravenous immunoglobulin, increased sharing, and kidney-paired donation are very effective strategies for transplanting sensitized patients. However, a significant population of patients will not benefit from either kidney-paired donation or desensitization and will require a hybrid technique in which the goal of matching is to reduce the strength of the DSA to facilitate desensitization.
人类白细胞抗原（HLA）致敏是一个主要的公共卫生问题，限制了 30%等待肾移植患者的移植机会。本篇综述描述了可供致敏患者选择的移植方式，并讨论了决定患者最适合选择的供体/受者表型的各个方面。
与仍在透析或等待匹配供体的相似患者相比，接受脱敏治疗的患者具有显著的生存获益。初始的供体特异性抗体（DSA）强度是预测脱敏治疗效果和成本的最佳指标。在小型、非对照的单中心试验中，补体抑制剂、蛋白酶体抑制剂和抗 CD20 已被用于预防和逆转抗体介导的排斥反应（AMR）。
随着新的治疗药物的出现，尽管这些药物尚未经过严格的研究，但需要强调的是，血浆置换、静脉注射免疫球蛋白、增加共享和肾配对捐赠是移植致敏患者的非常有效的策略。然而，仍有相当一部分患者将不能从肾配对捐赠或脱敏治疗中获益，而需要采用混合技术，其匹配目标是降低 DSA 的强度，以促进脱敏治疗。
