ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1451135
Use of HLA desensitization in the management of renal transplant recipients in Europe
Provisionally accepted
- 1Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- 2Clinical Department of Nephrology and Dialysis, University Clinic for Internal Medicine III, Medical University of Vienna, Vienna, Austria
- 3Other, New York, United States
- 4Bryter, New York, United States
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A significant challenge in kidney transplantation is overcoming immunological barriers such as human leukocyte antigen (HLA) incompatibilities. The presence of anti-HLA antibodies in the transplant candidate is referred to as HLA sensitization. As the degree of sensitization increases, the likelihood of finding a compatible organ decreases. Desensitization is the process of reducing recipient anti-HLA antibodies to acceptable levels to allow transplantation. Enthusiasm for the process has declined with focus turning to optimizing deceased donor allocation and paired kidney exchange programs. This research was designed to assess current practices around desensitization in Europe. A 15-minute online survey with 56 multiple choice or open-ended questions was completed by EU transplant nephrologists, transplant surgeons and nephrologists. Survey topics included kidney transplant caseloads, pretransplant desensitization and desensitization post-transplant. The results indicate high variation in what physicians consider to be the threshold mean fluorescence intensity (MFI) level for significant anti-HLA antibodies and the need for desensitization. Desensitization protocols are not standardized; while there is alignment on the usage of apheresis and IVIG, usage of other agents is variable. New therapies for desensitization are emerging which could aid in removing immunological barriers to transplantation for the most highly-sensitized patients.
Keywords: Desensitization, human leukocyte antigen (HLA), Kidney Transplantation, Donor-specific antibody (DSA), Antibodies, Anti-HLA antibody
Received: 18 Jun 2024; Accepted: 04 Aug 2025.
Copyright: © 2025 Rostaing, Böhmig, Taqi and Gibbons. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lionel PE Rostaing, Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
Georg A Böhmig, Clinical Department of Nephrology and Dialysis, University Clinic for Internal Medicine III, Medical University of Vienna, Vienna, Austria
Ben Gibbons, Bryter, New York, United States
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