title: Diagnosis and management of antibody-mediated rejection: current status and novel approaches.
abstract: Advances in multimodal immunotherapy have significantly reduced acute rejection rates and substantially improved 1-year graft survival following renal transplantation. However, long-term (10-year) survival rates have stagnated over the past decade. Recent studies indicate that antibody-mediated rejection (ABMR) is among the most important barriers to improving long-term outcomes. Improved understanding of the roles of acute and chronic ABMR has evolved in recent years following major progress in the technical ability to detect and quantify recipient anti-HLA antibody production. Additionally, new knowledge of the immunobiology of B cells and plasma cells that pertains to allograft rejection and tolerance has emerged. Still, questions regarding the classification of ABMR, the precision of diagnostic approaches, and the efficacy of various strategies for managing affected patients abound. This review article provides an overview of current thinking and research surrounding the pathophysiology and diagnosis of ABMR, ABMR-related outcomes, ABMR prevention and treatment, as well as possible future directions in treatment.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: A
authors.initials: A
authors.lastname: Djamali
authors.forename: D B
authors.initials: DB
authors.lastname: Kaufman
authors.forename: T M
authors.initials: TM
authors.lastname: Ellis
authors.forename: W
authors.initials: W
authors.lastname: Zhong
authors.forename: A
authors.initials: A
authors.lastname: Matas
authors.forename: M
authors.initials: M
authors.lastname: Samaniego
mesh_terms: D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D016377:Organ Transplantation
chemical_list: D007518:Isoantibodies
keywords: Antibody-mediated rejection; complement C4d; donor-specific antibodies; phenotype