Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes
Antibody-mediated rejection (AMR) is a major cause of late kidney transplant failure. It is important to have an understanding of human-leukocyte antigen (HLA) typing including well-designed studies to determine anti-MHC-class-I-related chain A (MICA) and antibody rejection pathogenesis. This can a...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2012/201754 |
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| author | Olivia R. Blume Sarah E. Yost Bruce Kaplan |
| author_facet | Olivia R. Blume Sarah E. Yost Bruce Kaplan |
| author_sort | Olivia R. Blume |
| collection | DOAJ |
| description | Antibody-mediated rejection (AMR) is a major cause of late kidney transplant failure. It is important to have an understanding of human-leukocyte antigen (HLA) typing including well-designed studies to determine anti-MHC-class-I-related chain A (MICA) and antibody rejection pathogenesis. This can allow for more specific diagnosis and treatment which may improve long-term graft function. HLA-specific antibody detection prior to transplantation allows one to help determine the risk for AMR while detection of DSA along with a biopsy confirms it. It is now appreciated that biopsy for AMR does not have to include diffuse C4d, but does require a closer look at peritubular capillary microvasculature. Although plasmapheresis (PP) is effective in removing alloantibodies (DSAs) from the circulation, rebound synthesis of alloantibodies can occur. Splenectomy is used in desensitization protocols for ABO incompatible transplants as well as being found to treat AMR refractory to conventional treatment. Also used are agents targeted for plasma cells, B cells, and the complement cascade which are bortezomib rituximab and eculizumab, respectively. |
| format | Article |
| id | doaj-art-18cf4f1923e34a7fa356dbe5f05b4520 |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-18cf4f1923e34a7fa356dbe5f05b45202025-02-03T06:08:30ZengWileyJournal of Transplantation2090-00072090-00152012-01-01201210.1155/2012/201754201754Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and OutcomesOlivia R. Blume0Sarah E. Yost1Bruce Kaplan2Abdominal Transplantation, University of Arizona Medical Center, Tucson, AZ, USAAbdominal Transplantation, Department of Pharmacy, University of Arizona Medical Center, Tucson, AZ, USAUniversity of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USAAntibody-mediated rejection (AMR) is a major cause of late kidney transplant failure. It is important to have an understanding of human-leukocyte antigen (HLA) typing including well-designed studies to determine anti-MHC-class-I-related chain A (MICA) and antibody rejection pathogenesis. This can allow for more specific diagnosis and treatment which may improve long-term graft function. HLA-specific antibody detection prior to transplantation allows one to help determine the risk for AMR while detection of DSA along with a biopsy confirms it. It is now appreciated that biopsy for AMR does not have to include diffuse C4d, but does require a closer look at peritubular capillary microvasculature. Although plasmapheresis (PP) is effective in removing alloantibodies (DSAs) from the circulation, rebound synthesis of alloantibodies can occur. Splenectomy is used in desensitization protocols for ABO incompatible transplants as well as being found to treat AMR refractory to conventional treatment. Also used are agents targeted for plasma cells, B cells, and the complement cascade which are bortezomib rituximab and eculizumab, respectively.http://dx.doi.org/10.1155/2012/201754 |
| spellingShingle | Olivia R. Blume Sarah E. Yost Bruce Kaplan Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes Journal of Transplantation |
| title | Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes |
| title_full | Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes |
| title_fullStr | Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes |
| title_full_unstemmed | Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes |
| title_short | Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes |
| title_sort | antibody mediated rejection pathogenesis prevention treatment and outcomes |
| url | http://dx.doi.org/10.1155/2012/201754 |
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