الفهرس | Only 14 pages are availabe for public view |
Abstract Kidney transplantation is the best choice for patients with end stage renal disease. There has been steady progress in renal allograft survival since the development of proper HLA matching and sufficient immunosuppressive therapy. Allograft survival depends on a number of immunologic factors that determine whether the graft will be rejected or not. These factors include HLA matching between donor and recipient, the pre-transplantation sensitization status of the recipient, and the ability of the recipient to recognize and respond to donor antigens. One or more mismatches in HLA-A, HLA-B, and HLA-DR antigens still reduce allograft survival significantly. Better HLA matched donor allografts have better survival. Antibodies directed against HLA antigens of a given organ donor represent the dominating reason for hyperacute or acute allograft rejections. In order to select recipients without donor-specific antibodies, a standard crossmatch procedure, the complement-dependent cytotoxicity assay, was developed. Enzyme-linked immunosorbent assay-based techniques have been designed to reliably detect anti- HLA antibodies in recipients. Kidney transplant recipients may develop de novo anti-HLA and non-HLA antibodies after transplantation. Although these antibodies may be donor-specific or non-donor specific, their presence may increase the risk for acute and chronic rejection, thereby decreasing allograft survival. |