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Kidney Transplantation in Sensitized Patients pp 91–99Cite as

Treatment of Rejection in Desensitized KT Patients

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Abstract

In the end-stage renal disease, kidney transplantation is considered as an optimal treatment. As understanding of pathophysiology of antibody-mediated rejection (ABMR), the challenges of sensitized kidney transplantation is increased with a tool of desensitizing protocol. In the sensitized kidney transplantation against donor-specific antibody (DSA) for human leukocyte antigen or ABO-incompatible antigen, the antibody-mediated rejection is still not been fully overcome. The many reports showed the rate of T cell-mediated rejection (TCMR) has greatly decreased but the treatment of antibody-mediated rejection is still difficult. Antibody-mediated rejection is main risk of deterioration of renal function and graft loss in kidney transplantation. Antibody-mediated rejection therapy is currently known to be effective for removing or inhibiting the creation of donor-specific antibodies. Plasmapheresis and intravenous immunoglobulin (IVIG) are known to be helpful, but there is no defined protocol. Rituximab or bortezomib have been used to inhibit the production of antibody-producing plasma cells or B cells, but have not yet shown good results, and eculizumab, c1 esterase inhibitor, and IgG endopeptidase require additional studies.

In this chapter various treatments against the antibody-mediated rejection will be dealt with in current use of medical therapy and newly developed medications.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, South Korea

    Joong-Kyung Kim MD

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  1. Joong-Kyung Kim MD
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  1. Department of General Surgery, Asan Medical Center, Seoul, Korea (Republic of)

    Duck Jong Han

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Kim, JK. (2020). Treatment of Rejection in Desensitized KT Patients. In: Han, D. (eds) Kidney Transplantation in Sensitized Patients. Springer, Singapore. https://doi.org/10.1007/978-981-10-7046-4_7

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  • DOI: https://doi.org/10.1007/978-981-10-7046-4_7

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  • Online ISBN: 978-981-10-7046-4

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