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2017 ; 8
(ä): 234
Nephropedia Template TP
Front Immunol
2017[]; 8
(ä): 234
PMID28321223
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ABO-incompatible (ABOi) kidney transplantation has long been considered a
contraindication to successful kidney transplantation. During the last 25?years,
increasing organ shortage enforced the development of strategies to overcome the
ABO antibody barrier. In the meantime, ABOi kidney transplantation has become a
routine procedure with death-censored graft survival rates comparable to the
rates in compatible transplantations. Desensitization is usually achieved by
apheresis and B cell-depleting therapies that are accompanied by powerful
immunosuppression. Anti-A/B antibodies are aimed to be below a certain threshold
at the time of ABOi kidney transplantation and during the first 2?weeks after
surgery. Thereafter, even a rebound of anti-A/B antibodies does not appear to
harm the kidney transplant, a phenomenon that is called accommodation, but is
poorly understood. There is still concern, however, that infectious complications
such as viral disease, Pneumocystis jirovecii pneumonia, and severe urinary tract
infections are increased after ABOi transplantations. Recent data from the
Collaborative Transplant Study show that during the first year after kidney
transplantation, one additional patient death from an infectious complication
occurs in 100 ABOi kidney transplant recipients. Herein, we review the recent
evidence on ABOi kidney transplantation with a focus on desensitization
strategies and respective outcomes.
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