title: Antibody-incompatible kidney transplantation in 2015 and beyond.
abstract: Rejection caused by donor-specific antibodies (principally ABO and HLA antibodies) has become one of the major barriers to successful long-term transplantation. This review focuses on clinical outcomes in antibody-incompatible transplantation, the current state of the science underpinning clinical observations, and how these may be translated into further novel therapies. The clinical outcomes for allografts facing donor-specific antibodies are at present determined largely by the use of agents developed in the 20th century for the treatment of T-lymphocyte-mediated cellular rejection, such as interleukin-2 agents and anti-thymocyte globulin. These treatments are partially effective, because acute antibody-mediated rejection is mediated to a considerable extent by T lymphocytes. However these treatments are essentially ineffective in chronic antibody-mediated rejection. Future therapies for the prevention and treatment of antibody-mediated rejection are likely to fall into the categories of those that reduce antibody production, extracorporeal antibody removal and disruption of the effector arms of antibody-mediated tissue damage.
authors.affiliation: Renal Unit, University Hospitals Coventry and Warwickshire, Coventry, UK.
authors.forename: Rob M
authors.initials: RM
authors.lastname: Higgins
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Sunil
authors.initials: S
authors.lastname: Daga
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Dan A
authors.initials: DA
authors.lastname: Mitchell
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000906:Antibodies / Q000276:immunology*; D000920:Antibody-Dependent Cell Cytotoxicity; D001787:Blood Group Incompatibility; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies; D006680:HLA Antigens
keywords: ABO; HLA; antibody; antibody-mediated rejection; kidney transplant