Humoral immunity in renal transplantation: clinical significance and therapeutic approach.
Donor-specific antibodies (DSA) form a significant barrier in solid organ transplantation of highly pre-sensitized candidates. Although avoiding transplantation over a positive cross-match test can largely prevent the occurrence of hyperacute antibody-mediated rejection, transplantation of highly pre-sensitized candidates is often complicated by the occurrence of acute and chronic antibody-mediated graft rejection leading to diminished graft function and survival. The pre-existent HLA and/or non-HLA-specific antibodies are without any doubt important contributing factors underlying humoral-mediated graft injury. Furthermore, increasing evidence underlines the association of newly formed de novo DSA after transplantation with poor graft function and survival. There is still a need to further develop desensitizing therapies not only to make transplantation of highly pre-sensitized candidates feasible, but also to reduce the new formation of allo-antibodies. Here, we summarize current views on desensitization therapies and the impact of the presence of DSA on the fate of the kidney graft.
Rowshani
Ajda T
AT
Department of Internal Medicine, Renal Transplant Unit, Academic Medical Center, Amsterdam, The Netherlands. T.Rowshani@AMC.UVA.NL
Bemelman
Frederieke J
FJ
Lardy
Neubury M
NM
Ten Berge
Ineke J M
IJ
D000917:Antibody Formation / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*