PDF(Pubmed)
Abstract：
This guideline, from a European Society of Organ Transplantation (ESOT) working group, concerns the management of kidney transplant patients with HLA antibodies. Sensitization should be defined using a virtual parameter such as calculated Reaction Frequency (cRF), which assesses HLA antibodies derived from the actual organ donor population. Highly sensitized patients should be prioritized in kidney allocation schemes and linking allocation schemes may increase opportunities. The use of the ENGAGE 5 ((Bestard et al., Transpl Int, 2021, 34: 1005-1018) system and online calculators for assessing risk is recommended. The Eurotransplant Acceptable Mismatch program should be extended. If strategies for finding a compatible kidney are very unlikely to yield a transplant, desensitization may be considered and should be performed with plasma exchange or immunoadsorption, supplemented with IViG and/or anti-CD20 antibody. Newer therapies, such as imlifidase, may offer alternatives. Few studies compare HLA incompatible transplantation with remaining on the waiting list, and comparisons of morbidity or quality of life do not exist. Kidney paired exchange programs (KEP) should be more widely used and should include unspecified and deceased donors, as well as compatible living donor pairs. The use of a KEP is preferred to desensitization, but highly sensitized patients should not be left on a KEP list indefinitely if the option of a direct incompatible transplant exists.
摘要：
这个准则,来自欧洲器官移植学会（ESOT）工作组，与HLA抗体肾移植患者的管理有关.应使用虚拟参数定义敏化，如计算出的反应频率(cRF)、评估来自实际器官供体群体的HLA抗体。高度致敏的患者应优先考虑肾脏分配方案，而链接分配方案可能会增加机会。ENGAGE5的使用((Bestard等人,TransplInt,2021，34：1005-1018）推荐用于评估风险的系统和在线计算器。欧洲移植可接受的不匹配计划应该延长。如果寻找相容肾脏的策略不太可能进行移植，脱敏可以考虑，应该进行血浆置换或免疫吸附，补充有IViG和/或抗CD20抗体。较新的疗法，如imlifidase，可以提供替代方案。很少有研究将HLA不相容移植与保留在等待名单上进行比较，和发病率或生活质量的比较不存在。肾脏配对交换计划（KEP）应更广泛地使用，并应包括未指定和已故的捐赠者，以及相容的活体捐赠者对。使用KEP优于脱敏，但如果存在直接不相容移植的选择,高度致敏的患者不应无限期留在KEP名单上.
