Intravenous Gammaglobulin (IVIG): A Novel Approach to Improve Transplant Rates and Outcomes in Highly HLA-Sensitized Patients

S. C. Jordan; A. A. Vo; A. Peng; M. Toyoda; D. Tyan


American Journal of Transplantation. 2006;6(3):459-466. 

In This Article

Alternative Approaches to Improve Transplantation for Highly HLA-Sensitized Patients

As more transplant centers in the United States and around the world develop protocols to improve transplantation for the highly HLA-sensitized patients, other approaches have emerged. These include the use of plasmapheresis and IVIG currently used at Johns Hopkins and the Mayo Clinic.[9,22] Claas et al.[23] reported on The Acceptable Mismatch Program, which has been developed for allocating kidneys to highly sensitized patients. This protocol involves the use of a computer program, HLA Matchmaker, which allocates kidneys to patients based on avoidance of antigen sensitization. The authors report that 112 transplants have been performed with a 2-year graft survival of 87%. The authors give no data on the incidence and severity of rejection episodes and current serum creatinine values. They also suggest this be implemented in conjunction with desensitization protocols in an effort to transplant most highly sensitized patients. Other potential protocols include donor exchange programs that may improve access of highly sensitized patients to transplantation.[24] If these approaches are successful in the United States, they should be adopted prior to initiation of desensitization therapy.


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