title: The emerging role of complement inhibitors in transplantation.
abstract: The role of complement in the biology of kidney transplantation is becoming more and more significant, especially but not only because we now have access to drugs inhibiting complement. After describing the main characteristics of complement biology, both activation of the complement cascade and the many regulatory factors, we will review the precise role of complement in kidney transplant biology. Complement activation has been involved in ischemia-reperfusion injury, in the recurrence of several diseases such as atypical hemolytic uremic syndrome, C3 glomerulopathies, and antiphospholipid syndrome, as well as the process of antibody-mediated rejection, either acute or chronic. There are many potentially interesting drugs interfering with complement inhibition that have been or may be studied in kidney transplantation. Currently, the bulk of data concerns eculizumab, a monoclonal antibody blocking the complement cascade at the C5. Its efficacy has been demonstrated in the treatment and prevention of recurrence of atypical hemolytic uremic syndrome with an overall good safety profile. Although it has been reported to be efficacious to prevent antibody-mediated rejection, properly designed trials are currently being performed to state this efficacy. In addition, randomized trials are, in the process, regarding the prevention of ischemia-reperfusion injury after kidney transplantation.
authors.affiliation: Laboratoire d'Immunologie Biologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.|INSERM UMRS 1138, Cordeliers Research Center, Complement and Diseases Team, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Frémeaux-Bacchi
authors.affiliation: Service de Néphrologie-Transplantation, Hôpital Necker, AP-HP, Paris, France.|Université Sorbonne Paris Cité, Paris, France.|Unité INSERM U845, Hôpital Necker, Paris, France.
authors.forename: Christophe M
authors.initials: CM
authors.lastname: Legendre
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D051056:Complement Inactivating Agents / Q000627:therapeutic use*; D003165:Complement System Proteins / Q000276:immunology* / Q000378:metabolism*; D006801:Humans; D016030:Kidney Transplantation; D015427:Reperfusion Injury / Q000378:metabolism; D014181:Transplantation Immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D051056:Complement Inactivating Agents; D003165:Complement System Proteins; C481642:eculizumab