Conflicts of interest The authors declare no conflicts of interest.
Prevention and treatment of alloantibody-mediated kidney transplant rejection
Article first published online: 10 AUG 2011
© 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation
Volume 24, Issue 12, pages 1142–1155, December 2011
How to Cite
Bartel, G., Schwaiger, E. and Böhmig, G. A. (2011), Prevention and treatment of alloantibody-mediated kidney transplant rejection. Transplant International, 24: 1142–1155. doi: 10.1111/j.1432-2277.2011.01309.x
- Issue published online: 3 NOV 2011
- Article first published online: 10 AUG 2011
- Received: 15 April 2011 Revision requested: 1 June 2011 Accepted: 9 July 2011
- antibody-mediated rejection;
- kidney transplantation
Summary Antibody-mediated rejection (AMR), which is commonly caused by preformed and/or de novo HLA alloantibodies, has evolved as a leading cause of early and late kidney allograft injury. In recent years, effective treatment strategies have been established to counteract the deleterious effects of humoral alloreactivity. One major therapeutic challenge is the barrier of a positive pretransplant lymphocytotoxic crossmatch. Several apheresis- and/or IVIG-based protocols have been shown to enable successful crossmatch conversion, including a strategy of peritransplant immunoadsorption for rapid crossmatch conversion immediately before deceased donor transplantation. While such protocols may increase transplant rates and allow for acceptable graft survival, at least in the short-term, it has become evident that, despite intense treatment, many patients still experience clinical or subclinical AMR. This reinforces the need for innovative strategies, such as complementary allocation programs to improve transplant outcomes. For acute AMR, various studies have suggested efficiency of plasmapheresis- or immunoadsorption-based protocols. There is, however, no established treatment for chronic AMR and the development of strategies to reverse or at least halt chronic active rejection remains a big challenge. Major improvements can be expected from studies evaluating innovative therapeutic concepts, such as proteasome inhibition or complement blocking agents.