Author: Mark Stegall, M.D.
(Excerpt) "Donor-specific alloantibody is increasingly recognized as a major problem in renal transplantation. Whether present prior to transplantation or developing de novo after transplantation, the presence of DSA is a significant risk factor for premature graft loss. The past decade has seen the development of several novel therapeutic approaches to these patients. Paired donor programs now provide the possibility of either avoiding DSA completely or providing a donor against whom the recipient has much less antibody. Novel desensitization protocols have allowed successful transplantation of patients once considered untransplantable. Newer, more sensitive alloantibody detection assays have demonstrated that donor specific alloantibody (DSA) is a much more common than previously realized both pre and post-transplant. This review outlines our current understanding of alloantibody at various stages of transplantation and endeavors to assess the current treatment approaches to these difficult clinical problems. At the request of the editors, I also will address the challenges involved in clinical trial design in this area."