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Journal of Immunology Research
Volume 2017, Article ID 5201098, 8 pages
https://doi.org/10.1155/2017/5201098
Review Article

From Humoral Theory to Performant Risk Stratification in Kidney Transplantation

1Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
2Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3Department of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
4Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

Correspondence should be addressed to C. Lefaucheur; rf.oodanaw@ruehcuafel.nemrac

Received 20 October 2016; Accepted 15 December 2016; Published 2 January 2017

Academic Editor: Junchao Cai

Copyright © 2017 C. Lefaucheur et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of the present review is to describe how we improve the model for risk stratification of transplant outcomes in kidney transplantation by incorporating the novel insights of donor-specific anti-HLA antibody (DSA) characteristics. The detection of anti-HLA DSA is widely used for the assessment of pre- and posttransplant risks of rejection and allograft loss; however, not all anti-HLA DSA carry the same risk for transplant outcomes. These antibodies have been shown to cause a wide spectrum of effects on allografts, ranging from the absence of injury to indolent or full-blown acute antibody-mediated rejection. Consequently, the presence of circulating anti-HLA DSA does not provide a sufficient level of accuracy for the risk stratification of allograft outcomes. Enhancing the predictive performance of anti-HLA DSA is currently one of the most pressing unmet needs for facilitating individualized treatment choices that may improve outcomes. Recent advancements in the assessment of anti-HLA DSA properties, including their strength, complement-binding capacity, and IgG subclass composition, significantly improved the risk stratification model to predict allograft injury and failure. Although risk stratification based on anti-HLA DSA properties appears promising, further specific studies that address immunological risk stratification in large and unselected populations are required to define the benefits and cost-effectiveness of such comprehensive assessment prior to clinical implementation.