Phenotypes of antibody-mediated rejection in organ transplants

Authors

  • Michael Mengel,

    1. Department of Laboratory Medicine and Pathology, Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada
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  • Sufia Husain,

    1. Department of Laboratory Medicine and Pathology, Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada
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  • Luis Hidalgo,

    1. Department of Laboratory Medicine and Pathology, Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada
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  • Banu Sis

    1. Department of Laboratory Medicine and Pathology, Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada
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  • Conflicts of Interest
    The authors have no conflicts of interest to declare.

  • All authors were involved in text, figure and table preparation.

Michael Mengel, 3-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2S2, Canada. Tel.: 780-492-5943; fax: 780-492-0145; e-mail: mmengel@ualberta.ca

Summary

Antibody-mediated hyperacute rejection was the first rejection phenotype observed in human organ transplants. This devastating phenotype was eliminated by reliable crossmatch technologies. Since then, the focus was on T-cell-mediated rejection and de novo donor-specific antibodies were considered an epiphenomenon of cognate T-cell activation. The immune theory was that controlling the T-cell response would entail elimination of antibody-mediated rejection (ABMR). With modern immunosuppressive drugs, T-cell-mediated rejection is essentially treatable. However, this did not prevent ABMR from emerging as a significant phenotype in all types of organ transplants. It became obvious that both rejection types require distinct treatment and thus reliable diagnosis. This is the current challenge. ABMR, depending on stage, grade, time course, organ type or prior treatment, can present with a wide spectrum of phenotypes. This review summarizes the current diagnostic consensus for ABMR, describes unmet needs and challenges in diagnostics, and proposes new approaches for consideration.

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