Managing the highly sensitized transplant recipient and B cell tolerance

The detection of anti-donor-HLA antibodies in a renal allograft recipient's serum, either at the time of or after transplantation, is usually associat ed with specific antibody-mediated clinical syndromes. These can be divided temporally into three categories: hyperacute rejection, acute humoral reje ction and chronic humoral rejection. With the identification of new immunos uppressive drug combinations, more-effective control of alloantibody produc tion has been recently achieved in humans. Thus, prevention and/or treatmen t of antibody-mediated allograft injury are now possible. Ultimately, the i nduction of mixed hematopoietic chimerism may allow us to overcome the prob lem of allosensitization and accept an allograft without chronic immunosupp ression.