Authors: Rowshani, Ajda T.¹; Bemelman, Frederieke J.¹; Lardy, Neubury M.²; ten Berge, Ineke J.M.¹

Source: Clinical Transplantation, Volume 22, Number 6, November/December 2008 , pp. 689-699(11)

Publisher: Wiley-Blackwell

Abstract:

Rowshani AT, Bemelman FJ, Lardy NM, ten Berge IJM. Humoral immunity in renal transplantation: clinical significance and therapeutic approach.

Clin Transplant 2008: 22: 689-699. © 2008 Wiley Periodicals, Inc. Abstract: 

Donor-specific antibodies (DSA) form a significant barrier in solid organ transplantation of highly pre-sensitized candidates. Although avoiding transplantation over a positive cross-match test can largely prevent the occurrence of hyperacute antibody-mediated rejection, transplantation of highly pre-sensitized candidates is often complicated by the occurrence of acute and chronic antibody-mediated graft rejection leading to diminished graft function and survival. The pre-existent HLA and/or non-HLA-specific antibodies are without any doubt important contributing factors underlying humoral-mediated graft injury. Furthermore, increasing evidence underlines the association of newly formed de novo DSA after transplantation with poor graft function and survival. There is still a need to further develop desensitizing therapies not only to make transplantation of highly pre-sensitized candidates feasible, but also to reduce the new formation of allo-antibodies. Here, we summarize current views on desensitization therapies and the impact of the presence of DSA on the fate of the kidney graft.

Keywords: anti-CD20 monoclonal antibodies; chronic antibody-mediated rejection; desensitization; donor-specific allo-antibodies; humoral rejection; kidney transplantation

Document Type: Review article

DOI: http://dx.doi.org/10.1111/j.1399-0012.2008.00872.x

Affiliations: 1: Department of Internal Medicine, Renal Transplant Unit, Academic Medical Center, Amsterdam 2: HLA Diagnostics Laboratory, Sanquin, Amsterdam, the Netherlands

Publication date: 2008-11-01

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