Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums
Abstract Whether sensitized patients wait for a compatible crossmatch with a deceased donor, enter a paired exchange program with the hope of finding a compatible living donor, or go through a desensitization protocol depends on a number of factors, not the least of which is the overall philosophy o...
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| Veröffentlicht in: | Human immunology 2009-08, Vol.70 (8), p.610-617 |
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| container_title | Human immunology |
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| creator | Gebel, Howard M Moussa, Omar Eckels, David D Bray, Robert A |
| description | Abstract Whether sensitized patients wait for a compatible crossmatch with a deceased donor, enter a paired exchange program with the hope of finding a compatible living donor, or go through a desensitization protocol depends on a number of factors, not the least of which is the overall philosophy of the transplant center. Centers such as ours take the position that donor-directed antibodies detected by solid phase assays (even those that are “weak”) present an unacceptable risk factor to the patient. This philosophy is predicated on the biologic role of the immune system, specifically that antibodies were generated in response to a non-self (allo) antigen and that a successful immune response eliminates that which caused its stimulation. Although obviously an oversimplification, this philosophy mandates a comprehensive evaluation of HLA antibodies in sensitized recipients. This article addresses the challenges and conundrums associated with human leukocyte antigen antibody identification. |
| doi_str_mv | 10.1016/j.humimm.2009.04.012 |
| format | Article |
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Centers such as ours take the position that donor-directed antibodies detected by solid phase assays (even those that are “weak”) present an unacceptable risk factor to the patient. This philosophy is predicated on the biologic role of the immune system, specifically that antibodies were generated in response to a non-self (allo) antigen and that a successful immune response eliminates that which caused its stimulation. Although obviously an oversimplification, this philosophy mandates a comprehensive evaluation of HLA antibodies in sensitized recipients. 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Centers such as ours take the position that donor-directed antibodies detected by solid phase assays (even those that are “weak”) present an unacceptable risk factor to the patient. This philosophy is predicated on the biologic role of the immune system, specifically that antibodies were generated in response to a non-self (allo) antigen and that a successful immune response eliminates that which caused its stimulation. Although obviously an oversimplification, this philosophy mandates a comprehensive evaluation of HLA antibodies in sensitized recipients. This article addresses the challenges and conundrums associated with human leukocyte antigen antibody identification.</description><subject>Allergy and Immunology</subject><subject>Antibody Formation</subject><subject>Desensitization, Immunologic</subject><subject>Donor-directed antibodies</subject><subject>Graft Rejection - blood</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Rejection - immunology</subject><subject>Graft Rejection - prevention & control</subject><subject>Histocompatibility</subject><subject>HLA alleles</subject><subject>HLA antibodies</subject><subject>HLA antigens</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Immunization</subject><subject>Immunosorbent Techniques</subject><subject>Isoantibodies - blood</subject><subject>Isoantibodies - immunology</subject><subject>Kidney Transplantation</subject><subject>Living Donors</subject><subject>Practice Guidelines as Topic</subject><subject>Risk Factors</subject><subject>Solid phase assays</subject><subject>Tissue and Organ Procurement</subject><subject>Transplantation Conditioning</subject><issn>0198-8859</issn><issn>1879-1166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk9v1DAQxS0EotvCN0AoJ05N8H8nHJCqhdJKK_VQOFuOPQGHxF7spFK_PV7tIqReepoZ682z9H6D0DuCG4KJ_Dg2v9bZz3NDMe4azBtM6Au0Ia3qakKkfIk2mHRt3baiO0PnOY8YY4UVf43OSMeU4Ipt0PglhpjqBMYu_gGqm91VZcLi--g85MqHKkEwU2WmKf5MZljKbP3eQ1jyp2obQ_YOkll86S4rG-f95O2_0QRXnsIaXFrn_Aa9GsyU4e2pXqAf11-_b2_q3d232-3Vrracy6UmjjkqBklb4kA5xYkwgnPacsl6RjpCCaHCCRASHDPQC2p71veS96IdYGAX6MPRd5_inxXyomefLUyTCRDXrKUSiiopnhVSTFquurYI-VFoU8w5waD3yc8mPWqC9QGGHvURhj7A0JjrAqOsvT_5r_0M7v_SKf0i-HwUQInjwUPS2ZZkLThfUl60i_65H54a2MmHAmD6DY-Qx7imAi9rojPVWN8fDuJwD7jDuLgy9heedLLq</recordid><startdate>20090801</startdate><enddate>20090801</enddate><creator>Gebel, Howard M</creator><creator>Moussa, Omar</creator><creator>Eckels, David D</creator><creator>Bray, Robert A</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>20090801</creationdate><title>Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums</title><author>Gebel, Howard M ; Moussa, Omar ; Eckels, David D ; Bray, Robert A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-1d3d25f6281de7d7415a54428463b319121125d5e56ed3aeb52cb3bb64b58fef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Allergy and Immunology</topic><topic>Antibody Formation</topic><topic>Desensitization, Immunologic</topic><topic>Donor-directed antibodies</topic><topic>Graft Rejection - blood</topic><topic>Graft Rejection - diagnosis</topic><topic>Graft Rejection - immunology</topic><topic>Graft Rejection - prevention & control</topic><topic>Histocompatibility</topic><topic>HLA alleles</topic><topic>HLA antibodies</topic><topic>HLA antigens</topic><topic>HLA Antigens - immunology</topic><topic>Humans</topic><topic>Immunization</topic><topic>Immunosorbent Techniques</topic><topic>Isoantibodies - blood</topic><topic>Isoantibodies - immunology</topic><topic>Kidney Transplantation</topic><topic>Living Donors</topic><topic>Practice Guidelines as Topic</topic><topic>Risk Factors</topic><topic>Solid phase assays</topic><topic>Tissue and Organ Procurement</topic><topic>Transplantation Conditioning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gebel, Howard M</creatorcontrib><creatorcontrib>Moussa, Omar</creatorcontrib><creatorcontrib>Eckels, David D</creatorcontrib><creatorcontrib>Bray, Robert A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Human immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gebel, Howard M</au><au>Moussa, Omar</au><au>Eckels, David D</au><au>Bray, Robert A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums</atitle><jtitle>Human immunology</jtitle><addtitle>Hum Immunol</addtitle><date>2009-08-01</date><risdate>2009</risdate><volume>70</volume><issue>8</issue><spage>610</spage><epage>617</epage><pages>610-617</pages><issn>0198-8859</issn><eissn>1879-1166</eissn><abstract>Abstract Whether sensitized patients wait for a compatible crossmatch with a deceased donor, enter a paired exchange program with the hope of finding a compatible living donor, or go through a desensitization protocol depends on a number of factors, not the least of which is the overall philosophy of the transplant center. 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| ispartof | Human immunology, 2009-08, Vol.70 (8), p.610-617 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Allergy and Immunology Antibody Formation Desensitization, Immunologic Donor-directed antibodies Graft Rejection - blood Graft Rejection - diagnosis Graft Rejection - immunology Graft Rejection - prevention & control Histocompatibility HLA alleles HLA antibodies HLA antigens HLA Antigens - immunology Humans Immunization Immunosorbent Techniques Isoantibodies - blood Isoantibodies - immunology Kidney Transplantation Living Donors Practice Guidelines as Topic Risk Factors Solid phase assays Tissue and Organ Procurement Transplantation Conditioning |
| title | Donor-reactive HLA antibodies in renal allograft recipients: Considerations, complications, and conundrums |
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