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Antibody Mediated Rejection, Preventive Desensitization Strategies, and Post-Transplant Diagnosis and Treatment

Antibody Mediated Rejection, Preventive Desensitization Strategies, and Post-Transplant Diagnosis and Treatment

Describe antibody mediated rejection and the current understanding of its features. Explain current pharmacological and non-pharmacological treatment and prevention interventions.

Product Details

This is a recording of a session that was presented at the 2014 Annual ITNS Symposium.

Track: Pharmacology

Title: Antibody Mediated Rejection: Past, Present, and Future of Antibody Mediated Rejection

Main Presenter: Timothy Humlicek, PharmD BCPS


Learning Objectives:

1. Discuss the pathogenesis of AMR.
2. Explain the histological and immunological features for the diagnosis of AMR.
3. Review the core therapeutic options for AMR.
4. Review the therapeutic approaches and various strategies for transplanting patients at high risk for AMR.

Description:

Describe antibody mediated rejection and the current understanding of its features. Explain current pharmacological and non-pharmacological treatment and prevention interventions.


References:

1. Chih S et al. Antibody-Mediated Rejection: An Evolving Entity in Heart Transplantation. J Transplant. 2012:Article ID 210210:10 pages.
2. Sadaka B, Alloway RR, Woodle ES. Management of Antibody-Mediated Rejection in Transplantation. Surg Clin N Am. 2013;93:1451–1466.
3. Kim M, Martin ST, Townsend KR. Antibody-Mediated Rejection in Kidney Transplantation: A Review of Pathophysiology, Diagnosis, and Treatment Options. Pharmacotherapy. 2014;
4. Nankivell BJ, Alexander SI. Rejection of the Kidney Allograft. N Engl J Med. 2010;363:1451-62.
5. Knechtle SJ, Kwun J, Iwakoshi N. Prevention trumps treatment of antibody-mediated transplant rejection. J Clin Invest. 2010;120(4):1036–1039.
6. Mulley WR, Kanellis J. Understanding crossmatch testing in organ transplantation: A case-based guide for the general nephrologist. Nephrology. 2011:16(2);125-33.
7. None Provided. Anthony Nolan Research Institute. Nomenclature for Factors of the HLA System. Updated July 7, 2014. Available at http://hla.alleles.org/nomenclature/naming.html, Accessed August 5, 2014 Medzhitov R, Janeway CA. Innate immunity: impact on the adaptive immune response. Curr Opin Immuno. 1997;9(1):4-9.
8. Tinckam KJ. Basic Histocompatibility Testing Methods. In: Chandraker ed. Core Concepts in Renal Transplantation. 2012:21-42.
9. Djamali A et al. Diagnosis and Management of Antibody-Mediated Rejection Current Status and Novel Approaches. Am J Transplant. 2014:14(2);255-271.
10. Kobashigawa et al. Conference on Antibody-mediated Rejection. The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation. J Heart Lung Transplant. 2011:30(3)252-259.
11. Berry GJ, et al. The ISHLT working formulation for pathologic diagnosis of antibody-mediated rejection in heart transplantation: evolution and current status (2005–2011). J Heart Lung Transplant. 2011;30:601–611.
12. Marfo K et al. Desensitization Protocols and Their Outcome. Clin J Soc Nephro. 2011;6(4):922-36 Raghaven R et al. Bortezomib in Kidney Transplantation. J Transplant. 2010;Article ID 698594:6 pages.
13. None Provided. Asahi Kasei Medical Co. Plasmapheresis. Available at http://www.asahi-kasei.co.jp/medical/en/personal/cure/cure_01.html. Accessed August 5, 2014.
14. Ciatworthy MR. B-cell regulation and its application to transplantation. Transp. Int. 2013;27117-128.
15. Stegall MD, Chedid MF, Cornell LD. The role of complement in antibody mediated rejection in kidney transplantation. Nat Rev Nephrol . 2012;8:672.
16. Marfo K,  et al. Desensitization Protocols and Their Outcome. Clinical Journal of the American Society of Nephrology. 2011:6(4);922-936.
17. Stehlik J et al. Utility of virtual crossmatch in sensitized patients awaiting heart transplantation. J Heart Lung Transplant. 2009:28(11);1129-34.
18. Crowe DO, Fossey SC, Maltais S, Wigger MA. Virtual Crossmatch Predicts Compatibility for Heart Transplantation with Favorable Outcomes in Sensitized Patients.  J Heart Lung Transplant. 2013:32(4);S86-87.
19. George J. F., Kirklin J. K., Shroyer T. W., et al. Utility of posttransplantation panel-reactive antibody measurements for the prediction of rejection frequency and survival of heart transplant recipients. J Heart Lung Transplant. 1995;14((5)):856–864.
20. Taylor D. O., Edwards L. B., Boucek M. M., et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplant report—2007. J Heart Lung Transplant. 2007;26((8)):769–781.
21. Nwakanma LU. Influence of pretransplant panel-reactive antibody on outcomes in 8,160 heart transplant recipients in recent era. Ann Thorac Surg. 2007:84(5):1556-62.
22. Fuggle, SV, Martin, S. Toward performing transplantation in highly sensitized patients. Transplantation 2004; 78:186.
23. Jordan, SC, Pescovitz, MD. Presensitization: The problem and its management. Clin J Am Soc Nephrol 2006; 1:421.
24. Reinsmoen N. Evolving Paradigms for Desensitization in Managing Broadly HLA Sensitized Transplant Candidates. Discov Med 13(70):235-245, 2012.
25. Vo AA et al. Rituximab and Intravenous Immune Globulin for desensitization during renal transplantation. N Engl J Med 2008. 359:242-51.
26. Haririan A et al. Positive cross-match living donor kidney transplantation: Longer-term outcomes. Am J Transplant 9:536–542, 2009.

CEPTC Contact Hours: 1

Duration: 53 minutes

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Product Reviews

4 out of 5  ( 3 Reviews)
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Angela Phelps Aug 15, 2015 Report Abuse
Good info for all transplant Coordinators
Janyce Mclin, BSN,RN Apr 29, 2015 Report Abuse
This session provides an excellent, easy to understand overview of a very complex topic. Basic standard prevention strategies are discussed, along with newer treatment protocols that are not yet available at every transplant center. Great information for those new to transplantation as well as experienced nurses/coordinators. I would have ranked this 5 stars, however, at $35 for 1 CEPTC (members' price) the cost is about double what I expected to pay. That being said, I'm thrilled that ITNS has stepped forward to become the leader in providing online transplant-specific continuing education that includes the CEPTCs we need for recertification. I hope to see expansion of this area of the business and hopefully prices that are better aligned with other organizations who offer online CE modules.
Janyce Mclin, BSN,RN Apr 29, 2015 Report Abuse
This session provides an excellent, easy to understand overview of a very complex topic. Basic standard prevention strategies are discussed, along with newer treatment protocols that are not yet available at every transplant center. Great information for those new to transplantation as well as experienced nurses/coordinators. I would have ranked this 5 stars, however, at $35 for 1 CEPTC (members' price) the cost is about double what I expected to pay. That being said, I'm thrilled that ITNS has stepped forward to become the leader in providing online transplant-specific continuing education that includes the CEPTCs we need for recertification. I hope to see expansion of this area of the business and hopefully prices that are better aligned with other organizations who offer online CE modules.
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