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NDT Advance Access originally published online on March 25, 2008
Nephrology Dialysis Transplantation 2008 23(8):2454-2457; doi:10.1093/ndt/gfn108
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Approaches for transplanting the sensitized patient: biology versus pharmacology

Howard M. Gebel and Robert A. Bray

Department of Pathology, Emory University Hospital, Atlanta, GA 30322, USA

Correspondence and offprint requests to: Robert A. Bray, Emory University Hospital, Department of Pathology, Room F-149, 1364 Clifton Road, Atlanta, GA 30322, USA. Tel: +1-404-712-7317; Fax: +1-404-727-1579; E-mail: rbray@emory.edu

Keywords: alloimmunized; histocompatibility; renal transplantation

The first 150 words of the full text of this article appear below.



   Introduction
 
In 1969, Patel and Terasaki [1] reported that a positive cytotoxic crossmatch between donor lymphocytes and recipient serum was associated with early or immediate graft loss. From this seminal finding it quickly became apparent that the clinically relevant antibodies in a positive lymphocyte crossmatch were those directed against antigens encoded by the human major histocompatibility complex (MHC). These observations helped establish the human MHC as a major factor in allograft rejection. More importantly, this paper and those that followed helped solidify the belief that a positive lymphocyte crossmatch was a contraindication to renal transplantation. As a result, the field of clinical histocompatibility testing was established, driven by the need to identify the MHC proteins (called human leukocyte antigens, HLA) to which many patients possessed antibodies. It was quickly established that there were two categories of patients awaiting renal transplantation, namely those who are ‘sensitized’ (patients with HLA antibodies) . . . [Full Text of this Article]



   Biological approach
 


   Pharmacological approach
 


   Summary
 

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