Rationalizing Incompatible Living Donor Kidney Transplantation for Highly Sensitized Candidates

摘要

Purpose of Review Because highly sensitized kidney transplant candidates must draw from a large donor pool to find a biologically compatible donor, living donor transplantation is uncommon among HLA-sensitized patients in need of kidney transplantations. We review current data on treatment options for highly sensitized kidney transplant candidates and provide recommendations based on the evidence and our clinical experience. Recent Findings As kidney paired donation becomes more common in the USA, recent studies have published outcomes from large, multi-center national exchange programs. Recent national studies have also provided data on experience with HLA-incompatible kidney transplantation options for the highly sensitized candidate including paired kidney exchange, desensitization with HLA-incompatible transplantation, or waiting for a deceased donor transplant. This review summarizes the pros and cons of these options and provides recommendations for the highly sensitized patient with an incompatible living donor. Considerations include the likelihood of finding a biologically compatible donor, the degree of HLA-incompatibility and their associated outcomes in comparison to compatible transplantation, the downside of remaining on dialysis while waiting for a more suitable donor, and patient preference. Given the challenges in finding biologically compatible donors, HLA-incompatible transplantation is an appropriate option for many highly sensitized kidney transplant candidates.