News and Announcements

Andrea A. Zachary, Mary S. Leffell

Summary: Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute
contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft.

Keywords: desensitization, donor-specific antibodies, solid organ transplantation, hematopoietic stem cell transplantation, plasmapheresis, intravenous immunoglobulin

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  • As a new technologist in the field of Immunogenetics, I found this article quite beneficial as I continue to be exposed to the various protocols for transplanting sensitized patients at Johns Hopkins. Although my time in the field and at Johns Hopkins has been minimal, Ive seen the importance placed on desensitization at this institution, and appreciate the ability this article offers me to gain an increased understanding of the various protocols and impacts of HLA antibodies in the field of transplantation.

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