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Review
. 2023 Jan 23:4:100056.
doi: 10.1016/j.crimmu.2023.100056. eCollection 2023.

Novel insights in the clinical management of hyperimmune patients before and after transplantation

Vincenzo Grimaldi  1 , Martina Pagano  1 , Giusi Moccia  1 , Ciro Maiello  2 , Paride De Rosa  3 , Claudio Napoli  1   4
Affiliations
Review

Novel insights in the clinical management of hyperimmune patients before and after transplantation

Vincenzo Grimaldi et al. Curr Res Immunol. .

Abstract

Despite improvements in anti-Human Leucocyte Antigens antibody detection, identification, and characterization offer a better in peri-operative management techniques, antibodies remain a serious cause of morbidity and mortality for patients both before and after organ transplantation. Hyperimmune patients are disadvantaged by having to wait longer to receive an organ from a suitably matched donor. They could benefit from desensitization protocols in both pre- and post-transplantation period. Clinical studies are underway to highlight which best desensitization strategies could be assure the best outcome in both heart and kidney transplantation. Although most clinical evidence about desensitization strategies by using anti-CD20 monoclonal antibodies, proteasome inhibitors, anti-CD38 monoclonal antibodies, interleukin-6 blockade, cysteine protease and complement inhibitors, comes from kidney transplantation studies, many of the debated novel concepts can be easily applied to desensitization also in heart transplantation. Here, we discuss the candidates and recipients' management by using most common standard of care and novel therapeutics, desensitization endpoints, and strategies for future studies.

Keywords: Anti-HLA antibodies; Clinical trials; Desensitization strategies; Heart and kidney transplantation; Hyperimmune patients.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Risk stratification for monitoring and treatment of patient after heart and/or kidney transplantation, Post-transplantation Group: (a) In low-risk patients DSA screening has been carried out at least once 3–12 months after transplantation. (b) Intermediate-risk patients should be screened for DSAs already during the first month. If DSA is evidenced, a biopsy should be performed. (c) In high and very high risk patients the measurement of DSAs and a biopsy is recommended for all patients for the first 3 months after transplantation. In all these groups, the recommendations for subsequent treatment are based on the biopsy results.
See this image and copyright information in PMC

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