Diagnosis and Management of Antibody-Mediated Rejection: Current Status and Novel Approaches

Authors

  • A. Djamali,

    Corresponding author
    1. Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
    2. Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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  • D. B. Kaufman,

    1. Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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  • T. M. Ellis,

    1. Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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  • W. Zhong,

    1. Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
    2. Pathology and Laboratory Services, William S. Middleton Memorial Veterans Hospital, Madison, WI
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  • A. Matas,

    1. Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
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  • M. Samaniego

    1. Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
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Abstract

Advances in multimodal immunotherapy have significantly reduced acute rejection rates and substantially improved 1-year graft survival following renal transplantation. However, long-term (10-year) survival rates have stagnated over the past decade. Recent studies indicate that antibody-mediated rejection (ABMR) is among the most important barriers to improving long-term outcomes. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Additionally, new knowledge of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. Still, questions regarding the classification of ABMR, the precision of diagnostic approaches, and the efficacy of various strategies for managing affected patients abound. This review article provides an overview of current thinking and research surrounding the pathophysiology and diagnosis of ABMR, ABMR-related outcomes, ABMR prevention and treatment, as well as possible future directions in treatment.

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