Conflicts of Interest The authors have declared no conflicts of interest.
Antibody-mediated kidney allograft rejection: therapeutic options and their experimental rationale
Article first published online: 6 MAR 2012
© 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation
Special Issue: Special Focus - Antibody-Mediated Rejection
Volume 25, Issue 6, pages 623–632, June 2012
How to Cite
Fehr, T. and Gaspert, A. (2012), Antibody-mediated kidney allograft rejection: therapeutic options and their experimental rationale. Transplant International, 25: 623–632. doi: 10.1111/j.1432-2277.2012.01453.x
- Issue published online: 15 MAY 2012
- Article first published online: 6 MAR 2012
- Received: 21 October 2011 Revision requested: 29 November 2011 Accepted: 2 February 2012 Published online: 6 March 2012
- antibody-mediated rejection;
- intravenous immunoglobulin;
With the advent of novel therapies to directly intervene with B cell immunity and complement activation, antibody-mediated kidney allograft rejection (AMR) has come into the focus of transplant immunologists. Intravenous immunoglobulin, rituximab, bortezomib, and eculizumab have been used to treat patients with acute AMR, apart from the standard treatment of antibody removal with plasma exchange or immunoadsorption and steroid pulses. This article describes the experimental rationale and summarizes the still limited clinical experience with these novel therapies in the transplant setting. Results with the standard treatment for acute AMR, including intense plasmapheresis, intravenous immunoglobulins, and steroids are good with a graft survival of 80% at 18 months. In contrast, patients suffering from chronic AMR have significant irreversible damage in their grafts with substantially impaired graft survival. Thus, the authors propose a step-wise escalation of therapy in refractory cases of acute AMR and advocate an urgent need for controlled therapeutic trials for acute and chronic AMR not to inflict unnecessary harm on our patients by uncontrolled polypragmasy.