Altindal Mahmut, Guldan Mustafa, Ozbek Lasin, Abdel-Rahman Sama Mahmoud, Unlu Selen, Murt Ahmet, Hasbal Nuri B, Yildiz Abdulmecit, Ferro Charles J, Covic Adrian, Süsal Caner, Kanbay Mehmet
Department of Medicine, Section of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
Clin Kidney J. 2025 Jul 9;18(8):sfaf219. doi: 10.1093/ckj/sfaf219. eCollection 2025 Aug.
Despite development of kidney paired donation programs and prioritization in kidney allocation schemes, transplantation rates are still low and waiting times remain prolonged for highly sensitized kidney transplant recipients with broad human leukocyte antigen antibody reactivity. Desensitization confers an invaluable option improving access to kidney transplantation for sensitized patients who could not benefit from kidney paired donation programs and kidney allocation schemes. Conventional desensitization strategies use intravenous immunoglobulin combined with either plasmapheresis or monoclonal anti-CD20 antibodies. Imlifidase, IL-6 targeting agents, plasma cell-directed therapies, complement inhibitors, chimeric antigen receptor T-cell therapies, and B cell-activating factor inhibitors are emerging new options in the hope of enhancing and sustaining the efficacy of desensitization to improve allograft longevity. In this review, we discuss the rationale and outcome of desensitization with various strategies alone or in combination. Our aim is also to provide some insight for decision when pursuing desensitization might be successful or futile in sensitized patients.
尽管开展了肾配对捐赠项目并在肾脏分配方案中进行了优先排序，但对于具有广泛人类白细胞抗原抗体反应性的高敏肾移植受者，移植率仍然很低，等待时间仍然很长。脱敏为那些无法从肾配对捐赠项目和肾脏分配方案中受益的致敏患者提供了一个宝贵的选择，改善了他们获得肾移植的机会。传统的脱敏策略是使用静脉注射免疫球蛋白，联合血浆置换或单克隆抗CD20抗体。依姆利菲酶、白细胞介素-6靶向药物、浆细胞导向疗法、补体抑制剂、嵌合抗原受体T细胞疗法和B细胞活化因子抑制剂是新出现的选择，有望增强和维持脱敏效果，以提高移植肾的存活时间。在这篇综述中，我们讨论了单独或联合使用各种策略进行脱敏的基本原理和结果。我们的目的还在于为判断在致敏患者中进行脱敏何时可能成功或徒劳提供一些见解。
