title: Polyclonal and monoclonal antibodies in renal transplant: an update.
abstract: OBJECTIVE
  There are several monoclonal and polyclonal antibodies used in renal transplantation today, this article will discuss several agents, their updates and newer agents.
  
  
  RESULTS
  Antithymocyte globulin and interleukin-2 (IL-2) receptor blocker continue to be used as induction agents. The risk of acute rejection was higher in IL-2 receptor blockers mainly in the first year, but graft survivals were similar in both groups long term. Belatacept is the only approved intravenous maintenance immunosuppressive therapy which provides the benefit of glomerular filtration rate preservation, but it was associated with a higher risk of acute rejection and post-transplant lymphoproliferative disorder. Bortezomib may help decrease donor-specific antibody levels, but there are limited data to support its use for desensitization or rejection. Eculizumab may help in antibody-mediated rejection in some cases but has not shown promising long-term effects in high-risk individuals. Newer agents have been continuously tested for improved efficacy and safety.
  
  
  CONCLUSIONS
  Transplantation is the standard of care for end-stage renal disease patients, but we still have a long way to go, as we need to improve long-term outcomes. The manipulation of the immune system is a delicate undertaking, with risks of adverse events; therefore, risk versus benefit needs to be carefully evaluated and treatment needs to be individualized.
authors.affiliation: Department of Nephrology, Kansas University Medical Center, Kansas City, Kansas, USA.
authors.forename: Amna
authors.initials: A
authors.lastname: Ilahe
authors.forename: Pooja
authors.initials: P
authors.lastname: Budhiraja
authors.forename: B
authors.initials: B
authors.lastname: Kaplan
mesh_terms: D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use*; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000628:therapy*; D016030:Kidney Transplantation
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents