Journal List > J Korean Soc Transplant > v.27(1) > 1034416

J Korean Soc Transplant. 2013 Mar;27(1):6-14. Korean.
Published online March 31, 2013.  https://doi.org/10.4285/jkstn.2013.27.1.6
Copyright © 2013 The Korean Society for Transplantation
Update on the Treatment of Acute and Chronic Antibody-mediated Rejection
Kwan-Tae Park, M.D.,1 Cheol-Woong Jung, M.D.,1 and Myung-Gyu Kim, M.D.2
1Department of Transplantation and Vascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
2Department of Nephrology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Corresponding author (Email: davidp1@hanafos.com )
Received March 12, 2013; Accepted March 13, 2013.

Abstract

Antibody-mediated rejection (AMR) by preformed and/or de novo human leukocyte antigen alloantibodies is a leading cause of early and late allograft loss. In this review, we describe strategic approaches to various forms of AMR in clinical settings that are not based on pathologic classification, which is controversial for atypical AMR (C4d-, DSA-, subclinical etc.). For acute AMR, a variety of modalities like plasmapheresis, intravenous immunoglobulin, and anti-CD20 antibodies have been utilized singly, or in combination, with variable results; however, no established treatment for chronic AMR is known. Significant research efforts are being made for developing new and novel therapies. Improvements in clinical outcomes can be expected from studies evaluating innovative therapeutic concepts, such as proteasome inhibition or complement-blocking agents.

Keywords: Transplantation; Rejection; Antibodies

Figures


Fig. 1
Target points of various therapeutic modalities. A schematic pathway of the steps needed to develop antibody-mediated rejection (AMR) after transplantation and the discrete activities of the various therapeutic modalities against AMR are depicted. Reprinted from Fig. 1 of reference (11). Abbreviation: IVIG, intravenous immunoglobulin.
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Fig. 2
Antihumoral treatment concepts. Most protocols combine two major therapeutic principles: apheresis for antibody depletion and modulation of B cell immunity and other components of adaptive and innate immunity. Reprinted from Fig. 1 of reference (12). Abbreviations: IVIG, intravenous immunoglobulin; ATG, antithymocyte globulin.
Click for larger image


Fig. 3
Therapeutic approach to acute antibody-mediated rejection (AMR). Reprinted from Fig. 3 of reference (5). Abbreviations: PRA, panel reactive antibody; IV, intravenous; DSA, donor specific antibody.
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Tables


Table 1
Summary of antibody-mediated changes in Banff '09 updatea
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