Transplantation in highly sensitized patients: challenges and recommendations

Expert Review of Clinical Immunology
Sebastiaan Heidt, Frans H J Claas

Abstract

Highly sensitized patients awaiting a kidney transplant accrue on the transplant waiting list. The breadth of HLA antibodies in this subpopulation of patients precludes receiving a compatible organ offer through regular allocation within an acceptable time-frame. Areas covered: Several alternative options to receive a transplant exist for these patients, including additional priority in regular allocation, special programs based on allocation through acceptable antigens, kidney paired donation programs, desensitization protocols, or a combination of the latter two. In this review, these options and their outcomes are discussed as well as some possibilities to further enhance transplantation of this disadvantaged group of patients. Expert commentary: For highly sensitized patients, special attention is required, for which several strategies may apply. A step-wise approach may be the optimal strategy to facilitate successful transplantation of highly sensitized patients.

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Citations

Jun 4, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Sebastiaan HeidtFrans H J Claas
Nov 24, 2020·HLA : Immune Response Genetics·Helena CarSebastiaan Heidt
Jan 12, 2021·International Journal of Immunogenetics·William LemieuxRuth Sapir-Pichhadze
Jun 8, 2021·Frontiers in Immunology·Nizar JoherPhilippe Grimbert

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