CME on Transplantation is dedicated to online CME conferences, courses and presentations (slides with voice over) on transplantation, given by local and international experts. Its mission is to keep you up-to-date with the most recent developments on transplantation.
Presentation
"Transplanting the sensitized patient" Pr. Denis Glotz (biography) English - 2004-02-28 - 32 minutes
(52 slides)
Summary : In this presentation Dr Glotz discusses aspects relating to transplantation of the sensitized patient, such as identifying patients at high risk for sensitization, and the use of desensitization protocols.
The presence of both anti-Class I and anti-Class II HLA antibodies pretransplant has been shown to reduce the 2 year graft survival rate in kidney transplant recipients (1). A potential cause of sensitization is blood transfusion associated with either transplantation or pregnancy (2). It is however possible to predict which patients will develop anti-HLA antibodies after transfusion, says Dr Glotz, by using the flow cytometry assay to detect low titre antibodies.
It has been shown that patients developing anti-idiotypic antibodies to anti-HLA antibodies have improved graft survival rates (3). Detection of anti-idiotypic antibodies in the patient can be done by mixing current and historical sera and observing the percent inhibition of anti-HLA antibody (4). Desensitization protocols are thus one option for increasing the chances of obtaining a transplant for the sensitized patient. It has been shown that administration of intravenous immunoglobulins causes a sustained decrease in the titre of anti-HLA antibodies (5), and Dr Glotz describes the studies done by his group (5, 6) and others using this type of protocol.
Learning objectives : The participant will learn about protocols using intravenous immunoglobulins against anti-HLA antibodies in the sensitized patient.
4. MacLeod AM, al-Muzairai IA, Innes A, Power DA, Stewart KN, Catto GR. "Modulation of lymphocytotoxic activity in highly sensitised patients by anti-idiotypic antibodies." Transplant Proc. 1989 Feb;21(1 Pt 1):756-7.
