Therapeutic Apheresis in Prevention and Treatment of Antibody-Mediated Rejection of Renal Allografts

Abstract

Antibody-mediated rejection represents a significant barrier to favorable long-term outcomes after kidney transplantation and remains the most common cause of allograft failure. Therapeutic apheresis techniques are commonly used, in combination with other treatments such as immunosuppressive drugs, in the pre-transplant and post-transplant protocols for the prevention and treatment of antibody-mediated injury. The rationale is to remove the donor-specific antibodies and the other inflammatory mediators, which include cytokines, chemokines, and complement degradation molecules, and it is also related to immunomodulatory effects which determine an increased susceptibility of cell-mediated and humoral immunity to immunosuppressive agents. In the present review article, current knowledge regarding the use of therapeutic apheresis in combination with the known and emerging biological immunosuppressive therapies, for the prevention and management of antibody-mediated rejection, has been discussed.