title: Phenotypes of antibody-mediated rejection in organ transplants.
abstract: 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.
authors.affiliation: Department of Laboratory Medicine and Pathology, Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada. mmengel@ualberta.ca
authors.forename: Michael
authors.initials: M
authors.lastname: Mengel
authors.forename: Sufia
authors.initials: S
authors.lastname: Husain
authors.forename: Luis
authors.initials: L
authors.lastname: Hidalgo
authors.forename: Banu
authors.initials: B
authors.lastname: Sis
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001787:Blood Group Incompatibility / Q000175:diagnosis / Q000276:immunology; D002908:Chronic Disease; D015935:Complement C4b / Q000378:metabolism*; D003937:Diagnosis, Differential; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology; D016377:Organ Transplantation; D010446:Peptide Fragments / Q000378:metabolism*; D010641:Phenotype; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d