HLA Desensitization in Kidney Transplants

Question 1

MHC Class 1

• made up of what?
• where is it expressed?
• what does it present to?

Answer 1

• expressed on all nucleated cells

- presents to cytotoxic T cells

Question 2

MHC Class 2

• made up of what?
• where is it expressed?
• what does it present to?

Answer 2

• expressed on antigen presenting cells

- presents to helper T cells

Question 3

What are the situations in which one might be sensitized to HLA?

Answer 3

Pregnancy
Transfusion
Transplantation

Question 4

What is the importance of HLA compatible transplants?

Answer 4

Need to be HLA compatible in order to:

• decrease risk of HLA sensitization
• Prevent rejection due to HLA
• Increased survival rate of patient

Question 5

What class of MHC is most important to match during transplants?

Answer 5

Class 1

Question 6

Given patient and donor HLA antigen and antibody type, predict the treatment for a patient

Answer 6

(see Brad’s chart example)
if HLA compatible? - do kidney transplant
if not compatible? - try to desensitize
If transplant not available or HLA antibody can’t be removed? - use dialysis

Question 7

Compare and contrast possible treatments for HLA sensitized end stage renal disease patient

Answer 7

• Kidney Transplant: best long-term outcome
• HLA desensitization: Best survival rate
• Long-term dialysis: last resort
  (transplant after desensitization is best treatment)

Question 8

What testing is used to identify the percentage of compatible donors?

Answer 8

PRA (Panel Reactive Antibody)