Desensitization in Solid Organ Transplantation

Abstract

Solid organ transplantation (SOT) has revolutionized the management of end-stage organ disease. Human Leukocyte antigen (HLA) sensitization and ABO incompatibility (ABOi) pose formidable barrier to SOT. The risk of acute rejection is high. They wait longer for compatible organs than their counterparts do. Furthermore, the graft and patient survival are suboptimal in incompatible transplants. Access to SOT could be promoted in this population by prioritizing them to well-matched organs in the allocation system via acceptable mismatch or paired donation programs. If these strategies fail to achieve transplantation, desensitization could provide an alternative. Desensitization is a process that allows transplantation in highly sensitized and ABO incompatible donor and recipient. Researchers initially developed principles of desensitization for kidney transplantation and have subsequently applied them to other types of solid organ transplantation. Desensitization protocols vary by the transplant center, but most use combinations of apheresis, intravenous immunoglobulin (IVIG), and anti-CD20 monoclonal antibodies. The desensitization aims to ease the immunological détente by removing preformed donor-specific alloantibodies (DSA) and creating a favorable immune environment for the allograft. Desensitization caries risk; therefore, careful patient selection and close monitoring are essential to mitigate the risk of complications. Further work is required to enhance the outcomes of desensitization.