KIDNEY-TRANSPLANTATION IN HIGHLY SENSITIZED PATIENTS - REAPPRAISAL OFETIOLOGY, EVALUATION, AND MANAGEMENT PROTOCOLS

Transplant recipient sensitization to major histocompatibility complex (MHC) antigens is a major problem in clinical organ transplantation i n terms of both magnitude and implication. Highly sensitized patients (HSPs) waiting for renal transplantation constitute a high-risk group with difficult management problems. In this review the factors involve d in sensitization, detection of sensitization in the pretransplant pe riod, various strategies tried in its prevention, and the current ther apeutic approach to management of HSPs are discussed. Although prevent ion of sensitization is ideal, in practice a certain percentage of tra nsplant recipients continue to exhibit hypersensitization despite all measures. Methods to remove preformed antibodies are effective but are expensive and not freely available. Aggressive immunosuppresion based on cyclosporine (CsA) induction protocols constitute the mainstay in the management of HSPs. The availability of newer, potent, and more sp ecific immunosuppressive agents, particularly those suppressing antibo dy synthesis, has opened a new avenue for more specific immunosuppress ion and better graft and patient survival following transplantation. T heir clinical utility in improving patient and graft survival in HSPs needs to be evaluated.