European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group.
European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group.
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DOI：
10.3389/ti.2022.10511
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发表时间：
2022
影响因子：
3.1
通讯作者：
Naesens, Maarten
中科院分区：
文献类型：
--
作者：
Mamode, Nizam;Bestard, Oriol;Claas, Frans;Furian, Lucrezia;Griffin, Sian;Legendre, Christophe;Pengel, Liset;Naesens, Maarten
这份指南来自欧洲器官移植协会(ESOT)的一个工作组，涉及对患有人类白细胞抗原抗体的肾移植患者的管理。应使用虚拟参数定义致敏作用，如计算的反应频率(CRF)，它评估来自实际器官捐赠者群体的人类白细胞抗原抗体。高度敏感的患者应该优先考虑肾脏分配方案，而关联分配方案可能会增加机会。建议使用Engage 5(Bestard等人，Transpl Int，2021，34：1005-1018)系统和在线计算器来评估风险。欧洲移植可接受的错配计划应该延长。如果寻找相容肾脏的策略不太可能产生移植，可以考虑脱敏，应该通过血浆交换或免疫吸附，辅以IVIG和/或抗CD20抗体进行。新的治疗方法，如伊利非酶，可能会提供替代方案。很少有研究将人类白细胞抗原血型不合的移植与等待名单上的移植进行比较，也不存在发病率或生活质量的比较。肾配对交换计划(KEP)应该得到更广泛的应用，应该包括未指明的和已故的捐赠者，以及相容的活体捐赠者对。使用KEP优于脱敏，但如果存在直接血型不合移植的选择，高度致敏的患者不应无限期地留在KEP名单上。
This guideline, from a European Society of Organ Transplantation (ESOT) working group, concerns the management of kidney transplant patients with HLA antibodies. Sensitization should be defined using a virtual parameter such as calculated Reaction Frequency (cRF), which assesses HLA antibodies derived from the actual organ donor population. Highly sensitized patients should be prioritized in kidney allocation schemes and linking allocation schemes may increase opportunities. The use of the ENGAGE 5 (Bestard et al., Transpl Int, 2021, 34: 1005–1018) system and online calculators for assessing risk is recommended. The Eurotransplant Acceptable Mismatch program should be extended. If strategies for finding a compatible kidney are very unlikely to yield a transplant, desensitization may be considered and should be performed with plasma exchange or immunoadsorption, supplemented with IViG and/or anti-CD20 antibody. Newer therapies, such as imlifidase, may offer alternatives. Few studies compare HLA incompatible transplantation with remaining on the waiting list, and comparisons of morbidity or quality of life do not exist. Kidney paired exchange programs (KEP) should be more widely used and should include unspecified and deceased donors, as well as compatible living donor pairs. The use of a KEP is preferred to desensitization, but highly sensitized patients should not be left on a KEP list indefinitely if the option of a direct incompatible transplant exists.
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影响因子：
3.1
作者：
Bestard, Oriol;Couzi, Lionel;Thaunat, Olivier
通讯作者：
Thaunat, Olivier
影响因子：
8.8
作者：
Delmonico, FL;Morrissey, PE;Rohrer, RJ
通讯作者：
Rohrer, RJ
影响因子：
20.3
作者：
DAUSSET, J;NENNA, A;BRECY, H
通讯作者：
BRECY, H
配对交换中兼容的活捐赠者接收对的动机和结果。
DOI：
10.1111/ajt.16821
发表时间：
2022-01
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
通讯作者：
--
影响因子：
6.2
作者：
Amrouche, Lucile;Aubert, Olivier;Legendre, Christophe
通讯作者：
Legendre, Christophe