Tham khảo tài liệu 'understanding the complexities of kidney transplantation part 9', y tế - sức khoẻ, sức khỏe người cao tuổi phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | Desensitization and Induction Immunosuppressive Therapy in Highly HLA-Sensitized Patients Receiving Cadaveric Renal Allograft 455 IVIG. Patients with low baseline antibody titers responding to high dose IVIG may do equally as well with further optimization of therapy. However whether or not the administration of rituximab or the routine post-transplant administration of IVIG would be of benefit in reducing the incidence of acute rejection in a high dose IVIG protocol is unclear at this time as this study not included randomization and only participated a low numbers of patients. 4. Remarks and conclusions The main goal of monitoring circulating antibodies is to measure PRA and identify specific antibodies in order to evaluate the patient s immunological risk and interpret a crossmatch. The introduction of HLA antibody characterization based on interactions between recipient serum and purified HLA antigens bound to solid-phase substrates has improved detection and quantification of donor-specific antibodies DSAs . Currently few kidney transplant options exist for hypersensitive patients on the waiting list if they do not undergo previously to desensitising treatments or strong induction therapy. In this respect high doses of intravenous immunoglobulins may reduce the level of circulating antibodies but many patients only respond partially and the efficacy varies among patients. Plasmapheresis can decrease circulating antibodies but there is normally a significant increase in their titre levels once the sessions have been completed. Therefore this technique is now considered a complement to the use of immunoglobulins for decreasing antibody levels. Likewise rituximab has also been shown to have a beneficial effect when combined with immunoglobulins and plasmapheresis to reduce anti-HLA antibodies rate and to treat antibody-mediated rejection. On the other hand newer interventions aimed at the prevention of DSA-mediated allograft injury using complement blockade or .
