Desensitization in kidney transplantation: Review

Jamilya Saparbay 1 * , Mels Assykbayev 1, Saitkarim Abdugafarov 1, Gulnur Zhakhina 1, Janat Spatayev 1, Asan Zhexembayev 1, Zhuldyz Zhanzakova 2, Aida Turganbekova 2, Saniya Abdrakhmanova 2, Gulnara Kulkayeva 1
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1 Department of Organ Transplantation, National Research Oncology Center, Nur-Sultan, Kazakhstan
2 Department of Immunological Support of Organ Transplantation, Research and Production Center for Transfusiology, Nur-Sultan, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 6, pp. 32-34. https://doi.org/10.23950/jcmk/11423
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ABSTRACT

Sensitization to human leukocyte antigens (HLA) antigens is the main obstacle to getting the kidney either from a living or deceased donor. HLA sensitization occurs as the result of repeated pregnancy, blood transfusion, or previous transplantation. Overcoming the HLA incompatibility is one of the approaches to decrease the organ shortage. There are 3.5 % highly sensitized patients among 3012 patients on the waiting list for kidney transplantation in Kazakhstan.
In this review, we have discussed most common approaches of desensitization for HS kidney recipients. Huge progress has been made in the field of desensitization in transplant medicine worldwide. We suppose, that implementation the desensitization protocols in clinical guidelines will improve patient survival and outcome after kidney transplantation.
Keywords: kidney transplantation, HLA sensitization, immunology

CITATION

Saparbay J, Assykbayev M, Abdugafarov S, Zhakhina G, Spatayev J, Zhexembayev A, et al. Desensitization in kidney transplantation: Review. J CLIN MED KAZ. 2021;18(6):32-4. https://doi.org/10.23950/jcmk/11423

REFERENCES

  • Organization WH. Noncommunicable diseases (NCD) country profiles 2018: Kazakhstan. Geneva. Available at http//www.whoint/nmh/countries/2018/irq_en.pdf: World Health Organization; 2018
  • RSE on PCV “Republican center for coordination of transplantation and high-tech medical services” of the Ministry of health of the Republic of Kazakhstan. URL: https://transplant.kz/ru/statistika
  • Jager KI, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication- worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019; 34(11):1 803-5. DOI: 10.1093/ndt/gfz174
  • Cai J, Terasaki PI. The current trend of induction and maintenance treatment in patient of different PRA levels: a report on OPTN/UNOS Kidney Transplant Registry data. Clin Transpl. 2010;45. PMID: 21696031
  • Ide, K., Tanaka, Y., Sasaki, Y., Tahara, H., Ohira, M., Ishiyama, K., & Ohdan, H. (2015). A phased desensitization protocol with rituximab and bortezomib for highly sensitized kidney transplant candidates. Transplantation direct, 1(5). doi: 10.1097/TXD.0000000000000526
  • Pavlasova, G., & Mraz, M. The regulation and function of CD20: an “enigma” of B-cell biology and targeted therapy. Haematologica. 2020; 105(6):1494. doi: 10.3324/haematol.2019.243543
  • Macklin, P. S., Morris, P. J., & Knight, S. R. A systematic review of the use of rituximab for desensitization in renal transplantation. Transplantation. 2014; 98(8):794-805. DOI: 10.1097/TP.0000000000000362
  • Casan, J. M. L., Wong, J., Northcott, M. J., & Opat, S. Anti-CD20 monoclonal antibodies: reviewing a revolution. Human vaccines & immunotherapeutics. 2018; 14(12):2820-2841. DOI: 10.1080/21645515.2018.1508624
  • Su, H., Zhang, C. Y., Lin, J. H., Hammes, H. P., & Zhang, C. The role of long-lived plasma cells in antibody-mediated rejection of kidney transplantation: an update. Kidney Diseases. 2019; 5(4):211-219. DOI: 10.1159/000501460
  • Kane, R. C., Bross, P. F., Farrell, A. T., & Pazdur, R. Velcade®: US FDA approval for the treatment of multiple myeloma progressing on prior therapy. The oncologist. 2003; 8(6):508-513. DOI: 10.1634/theoncologist.8-6-508
  • Clark, W. F., Huang, S. H. S., Walsh, M. W., Farah, M., Hildebrand, A. M., & Sontrop, J. M. (2016). Plasmapheresis for the treatment of kidney diseases. Kidney international. 2016; 90(5):974-984. doi.org/10.1016/j.kint.2016.06.009
  • Bajpai, M., Kakkar, B., Gupta, S., Rastogi, A., & Pamecha, V. Cascade plasmapheresis as a desensitization strategy for patients undergoing ABO incompatible living donor liver transplantation (ABOi LDLT): A single center experience. Transfusion and Apheresis Science. 2019; 58(4):442-446. DOI: 10.1016/j.transci.2019.04.028
  • Montgomery RA, Lonze BE, King KE, et al. Desensitization in HLA- incompatible kidney recipients and survival. N Engl J Med. 2011; 365:318–326. DOI: 10.1056/NEJMoa1012376
  • Orandi BJ, Luo X, Massie AB, et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med. 2016; 374:940–950. DOI: 10.1056/NEJMoa1508380
  • Jolles, S., Sewell, W. A. C., & Misbah, S. A. Clinical uses of intravenous immunoglobulin. Clinical and experimental immunology. 2005; 142(1):1. DOI: 10.1111/j.1365-2249.2005.02834.x
  • Kazatchkine, M. D., & Kaveri, S. V. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. New England Journal of Medicine. 2001; 345(10):747-755. DOI: 10.1056/NEJMra993360
  • Watanabe, J., & Scornik, J. C. IVIG and HLA antibodies. Evidence for inhibition of complement activation but not for anti‐idiotypic activity. American journal of transplantation. 2005; 5(11):2786-2790. DOI: 10.1111/j.1600-6143.2005.01056.x
  • Kuppachi, S., & Axelrod, D. A. Desensitization strategies: is it worth it? Transplant International. 2020; 33(3):251-259. DOI: 10.1111/tri.13532
  • Jordan, S. C., Legendre, C., Desai, N. M., Lorant, T., Bengtsson, M., Lonze, B. E., ... & Montgomery, R. A. Imlifidase Desensitization in Crossmatch-positive, Highly Sensitized Kidney Transplant Recipients: Results of an International Phase 2 Trial (Highdes). Transplantation. 2021; 105(8):1808. DOI: 10.1097/TP.0000000000003496
  • Orandi BJ, Garonzik-Wang JM, Massie AB, et al. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am J Transplant. 2014; 14:1573–1580. DOI: 10.1111/ajt.12786
  • Patel S, Benken J, West Thielke P, et al. Three year outcomes following positive cross match renal transplantation despite failure to convert to negative flow cross match after desensitization. J Clin Nephrol. 2018; 2:29–38. DOI: 10.29328/journal.jcn.1001016
  • Marfo K, Lu A, Ling M, et al. Desensitization protocols and their outcome. Clin J Am Soc Nephrol. 2011; 6:922–936. DOI: 10.2215/CJN.08140910
  • Marfo K, Lu A, Ling M, et al. Desensitization protocol and their outcomes. Clin J Am Soc Nephrol. 2011; 6:922,2011. DOI: 10.2215/CJN.08140910
  • Organ Procurement and Transplantation Network (OPTN).Scientific Registry of Transplant Recipients. 2012 Annual Data Report,2012);Scientific Registry of Transplant Recipients http://srtr.transplant.hrsa.gov/Resouces.aspx (9 January 2014, date last accessed)
  • Vo AA Choi J Cisneros Ket et al. Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med. 2008; 359:242-51. DOI: 10.1056/NEJMoa0707894
  • USRDS Renal Data System Report,2001
  • Orandi B.J.; Luo X., Massie A.B.; Garonzik-Wang J.M.; Lonze B.E. Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors. 374:940-50). DOI: 10.1056/NEJMoa1508380