Rostaing Lionel P E, Böhmig Georg A, Taqi Muhammed Mahdi, Gibbons Ben
Service de Nephrologie, Hemodialyse, Apherèses et Transplantation Renale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Clinical Department of Nephrology and Dialysis, University Clinic for Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Front Immunol. 2025 Aug 28;16:1451135. doi: 10.3389/fimmu.2025.1451135. eCollection 2025.
A significant challenge in kidney transplantation is overcoming immunological barriers such as human leukocyte antigen (HLA) incompatibilities. The presence of anti-HLA antibodies in the transplant candidate is referred to as HLA sensitization. As the degree of sensitization increases, the likelihood of finding a compatible organ decreases. Desensitization is the process of reducing recipient anti-HLA antibodies to acceptable levels to allow transplantation. Enthusiasm for the process has declined with focus turning to optimizing deceased donor allocation and paired kidney exchange programs. This research was designed to assess current practices around desensitization in Europe. A 15-minute online survey with 56 multiple choice or open-ended questions was completed by EU transplant nephrologists, transplant surgeons and nephrologists. Survey topics included kidney transplant caseloads, pre-transplant desensitization and desensitization post-transplant. The results indicate high variation in what physicians consider to be the threshold mean fluorescence intensity (MFI) level for significant anti-HLA antibodies and the need for desensitization. Desensitization protocols are not standardized; while there is alignment on the usage of apheresis and IVIG, usage of other agents is variable. New therapies for desensitization are emerging which could aid in removing immunological barriers to transplantation for the most highly-sensitized patients.
肾移植中的一个重大挑战是克服免疫障碍，如人类白细胞抗原（HLA）不相容性。移植候选者体内存在抗HLA抗体被称为HLA致敏。随着致敏程度的增加，找到相容器官的可能性降低。脱敏是将受者抗HLA抗体降低到可接受水平以允许移植的过程。随着关注点转向优化已故供体分配和配对肾交换项目，对该过程的热情有所下降。本研究旨在评估欧洲目前围绕脱敏的实践情况。欧盟的移植肾病学家、移植外科医生和肾病学家完成了一项为期15分钟的在线调查，其中包含56个多项选择题或开放式问题。调查主题包括肾移植病例数量、移植前脱敏和移植后脱敏。结果表明，医生们对于显著抗HLA抗体的阈值平均荧光强度（MFI）水平以及脱敏需求的看法存在很大差异。脱敏方案尚未标准化；虽然在单采和静脉注射免疫球蛋白（IVIG）的使用上达成了一致，但其他药物的使用情况各不相同。新的脱敏疗法正在出现，这可能有助于消除对致敏程度最高的患者进行移植的免疫障碍。
