title: Advances in pharmacotherapy to treat kidney transplant rejection.
abstract: BACKGROUND
  Current immunosuppressive combination therapy provides excellent prevention of T-cell-mediated rejection following renal transplantation; however, antibody-mediated rejection remains of high concern and accounts for a large number of long-term allograft losses. The recent development of protocol biopsies resulted in the definition of subclinical rejection (SCR), showing histologic evidence for rejection but unremarkable clinical course.
  
  
  METHODS
  This review describes the current knowledge and evidence of pharmacotherapy to treat kidney allograft rejections and covers SCR treatment options. Each substance is analyzed with regard to its classical indication and further discussed for the treatment of other forms of rejection.
  
  
  CONCLUSIONS
  Despite a lack of randomized trials, early acute T-cell-mediated rejection can be treated effectively in most cases without graft loss. The necessity to treat SCR is currently unclear. Due to a lack of effective therapies, new treatment approaches for antibody-mediated rejection are an urgent medical need to improve long-term outcomes. Future research should aim to better define pathophysiology and histology, stratify risk, and develop rational treatment strategies from randomized controlled trials, in order to establish the value of novel therapies in the arsenal of rejection pharmacotherapy. However, the effective prevention of rejection with minimal side effects still remains the goal in immunosuppression.
authors.affiliation: Charité Universitätsmedizin Berlin, Department of Nephrology , Berlin , Germany +49 30 450 514002 ; +49 30 450 514902 ; klemens.budde@charite.de.
authors.forename: Jamal
authors.initials: J
authors.lastname: Bamoulid
authors.forename: Oliver
authors.initials: O
authors.lastname: Staeck
authors.forename: Fabian
authors.initials: F
authors.lastname: Halleck
authors.forename: Michael
authors.initials: M
authors.lastname: Dürr
authors.forename: Alexander
authors.initials: A
authors.lastname: Paliege
authors.forename: Nils
authors.initials: N
authors.lastname: Lachmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Brakemeier
authors.forename: Lutz
authors.initials: L
authors.lastname: Liefeldt
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
mesh_terms: D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D013601:T-Lymphocytes / Q000276:immunology; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents
keywords: allograft rejection; antibody-mediated rejection; kidney transplantation; pharmacotherapy; subclinical rejection