Tuesday, February 2, 2010

Positive Cross Match, Desensitization

The recent AJT Report talks about fighting the positive Cross Match or desensitization.  Currently, many centers are using the combination of pheresis and low dose IVIG or high dose IVIG and rituximab is thrown in once in a while as well.  The value of rituximab is still questioned.  No one really knows how it is working in some and not in others.
There are few new agents:- one is bortezomib, a proteasome inhibitor that has shown some data in treating antibody mediated rejection.  There are some centers using one cycle pre and one cycle post transplant as densitization technique.  This has become a concern for many as people are starting to use it for indications that have not been systematically tested.  The side effect profile of this drug is not trivial. It includes peripheral neuropathy, pyrexia, anemia, leukopenia  and GI side effects.
Finally, the latest player in the market is eculizumab ( complement protein c5 inhibitor).  It has worked in some centers to treat antibody mediated rejection. Is it a good idea to use it for desensitization. Its early to say.

Lets wait and watch.

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