Current opinion in organ transplantation
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Recent outcome data, ongoing organ shortage and proposed changes in allocation policies are driving the need to review current practices and possible future course of kidney transplantation in the elderly patients. ⋯ Despite improved outcomes, there remain significant challenges to kidney transplantation in the elderly, including organ shortage, poor transplant rate, evolving allocation policies, high wait-list mortality and nonstandardized immunosuppression. Prospective studies are needed to evaluate the strategies to meet these challenges and to study the impact of proposed new allocation system.
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Curr Opin Organ Transplant · Aug 2009
ReviewThe role of the histocompatibility laboratory in desensitization for transplantation.
The ability of histocompatibility laboratories to define and monitor human leukocyte antigen (HLA)-specific antibodies via highly sensitive immunoassays has been a major contributing factor in the development of desensitization protocols for HLA-incompatible transplants. This review will focus on the laboratory's role in desensitization and the types of tests needed for determining the specificity and strength of antibodies to donor HLA pretransplant, during treatment, and after transplant. ⋯ Histocompatibility laboratories are essential components of desensitization programs. Thorough antibody characterization and serial monitoring of changes in antibody status are needed pretreatment, during treatment and after transplant. Because clinical decisions rely heavily on changes in antibody specificity and strength, desensitization should not be undertaken without access to appropriate histocompatibility testing.