Author: Everly MJ.
Based on our knowledge that donor specific anti-HLA antibodies (DSA) are a major cause of allograft loss, determining how to monitor patients for DSA and how to treat them is important. Current published studies indicate that patients with preformed DSA differ from those without. Approximately 15-18 percent of transplant patients will have preformed DSA, which increases risk for early antibody mediated rejection (AMR) and allograft loss. The fact that nearly all AMR episodes occur in the first 1-2 months, coupled with the finding that a reduction in preformed DSA intensity within the first few weeks post-transplant decreases the risk of AMR, makes early testing important. It has also been shown that clearance of DSA at 6 months and 1 year can result in a decreased risk of transplant glomerulopathy and therefore, these times may be prime testing points. This monitoring schedule differs slightly from that of the patients who do not have performed DSA (i.e. low risk patients). Low risk patients who develop de novo DSA are most likely to do so in the first 6 months. However, more frequent sampling in the early months does not improve predictability of acute rejections in low risk patients and therefore, it is not as essential.
Bingaman A, Kapturczak M, Murphey C, Wright F.
(Excerpt) "The kidney paired donation KPD program at Methodist Specialty and Transplant Hospital (MSTH) in San Antonio has significantly increased access to transplantation for patients with incompatible living donors, especially for disadvantaged group such as the highly sensitized population of repeat transplant patients and multiparous women. The KPD program increased overall live donor activity allowing MSTH to become the largest living donor kidney transplant center in the nation in 2009. In 2010, MSTH performed 193 living donor kidney transplants with 68 (35%) transplants from the KPD program. This demonstrates that an effective KPD program can significantly benefit difficult patients and increase transplant access and activity in a single center setting."