Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, 2145, Australia.
University of Sydney, Sydney, Australia.
Pediatr Nephrol. 2018 Dec;33(12):2239-2251. doi: 10.1007/s00467-017-3882-2. Epub 2018 Jan 13.
Transplantation is the preferred modality for renal replacement therapy in children. With increasing rates of re-transplantation within the paediatric population, there are more sensitised children on waiting lists. One issue with developing strategies to treat these children is the number of different definitions of sensitisation. and we would therefore recommend an immunological risk stratification approach.
We discuss methods of sensitisation prevention, assessment and management, including paired exchange programmes and desensitisation protocols.
There are limited published evidence-based data for desensitisation in adults and none in children; thus, we present information on the available therapies currently in use.
Further research is required to investigate strategies which prevent sensitisation in children, including the healthcare utility of incorporating epitope-based matching into organ allocation algorithms. Controlled studies are also needed to establish the most appropriate desensitisation regimen(s).
移植是儿童肾脏替代治疗的首选方式。随着儿科人群中再次移植率的增加，等待名单上有更多致敏儿童。制定治疗这些儿童的策略的一个问题是致敏的定义有很多不同。因此，我们建议采用免疫风险分层方法。
我们讨论了致敏预防、评估和管理的方法，包括配对交换计划和脱敏方案。
成人脱敏的循证数据有限，儿童则没有；因此，我们提供了目前使用的可用治疗信息。
需要进一步研究旨在预防儿童致敏的策略，包括将基于表位的匹配纳入器官分配算法的医疗保健效用。还需要对照研究来确定最合适的脱敏方案。
