[Diagnostic value of specific anty-HLA alloantibodies before and after renal transplantation. Programs for highly sensitized recipients]. / Znaczenie diagnostyczne swoistych aloprzeciwcial anty-HLA u chorych przed i po transplantacji nerek. Programy dla wysoko zimmunizowanych.

ABSTRACT

Anti-HLA alloantibodies are the main barrier in kidney transplantation. Lack of appropriate donors for highly sensitized (HS) recipients makes access to transplantation very difficult and results in a significant increase in both the time on the waiting list and the number of post-transplant complications in these patients. The transplantation itself is also associated with higher risk in the HS. There are many programs aimed at increasing access to renal transplantation for this group of recipients. It is noteworthy that new acceptable HLA-mismatches allowed significant progress in programs for HS recipients. Currently implemented programs (ET-AMP, UNOS, Emory algorithm) proved useful as they increased access to transplantation and graft survival in HS patients. Nevertheless, even with these programs there is still the problem of humoral rejection in these patients. The strong correlation between donor-specific antibodies (DSA) and graft rejection seen both immediately after transplantation and in long-term complications such as CAN (chronic allograft nephropathy) may be the simplest explanation for this effect. Hence the assessment of alloantibodies limited to the pre-transplant period, which is nowadays routine, seems insufficient. Current evidence suggests that early detection of post-transplant DSA may be an excellent prognostic marker of graft function and may allow implementing the necessary treatment prior to rejection.