Antibody Mediated Rejection in Kidney Transplant Recipients

Abstract

Antibody mediated rejection (ABMR) presents a significant challenge for long term graft survival in kidney transplantation. New technologies, including genomic studies and assays to detect and define donor-specific antibodies, have provided important insights into the pathophysiology and diagnosis of ABMR. Unfortunately, this progress has not yet translated into better outcomes for patients, as in the absence of a drug able to suppress antibody generation by plasma cells, available therapies can only slow down graft destruction. This chapter reviews the current understanding of ABMR, and details its diagnosis, and treatments, both those established in current routine clinical practice and those on the horizon.

Tissue miRNA Profile Is Associated with Acute Tubular Necrosis, Rejection Phenotypes and BK Polyomavirus-Associated Nephropathy in Human Kidney Allografts

“…Specifically, after initial reduction of immunosuppression in patients with large amount of BK copies in serum, BKPyVAN and TCMR may be present simultaneously and indistinguishable from each other without additional signs of rejection, such as endarteritis [33]. However, the correct differentiation of both diseases in patients remains crucial, as in BKPyVAN the therapeutic approach is just the opposite to rejection [34], so the search for additional biomarkers to accurately distinguish disease processes would be of great value.…”