Fig. 5.1
University of Maryland alloantibody removal protocol for live donor kidney recipients who have a positive crossmatch with their donor
Fig. 5.2
Graft survival in positive crossmatch cases compared with controls
Fig. 5.3
Graft survival in positive crossmatch group in those who achieved negative crossmatch versus those with persistently positive flow crossmatch at the time of transplant following course of desensitization
Future Directions
If regimen of administering IVIG to patients on the transplant wait list (such as those protocols of monthly infusions with dialysis described above) is found to be effective, logistically feasible, cost-effective in clinical practice, then perhaps this could be an option for highly sensitized kidney transplant candidates who are unable to find a living donor. Also, given the evidence that chimerism or microchimerism may be involved in the genesis of sustained sensitization and given the inability to produce long-term suppression of sensitization with our current regimens, some authors have suggested that actively eliminating chimerism in sensitized patients may provide an alternative strategy to control alloimmunization [31]. Immunopotentiating agents such as interferon or administration of antibodies with specificity of chimeric HLA are two strategies that could be employed in the near future.
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Urologic Issues in the Renal Transplant Patient
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