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Journal of Transplantation
Volume 2012, Article ID 201754, 7 pages
http://dx.doi.org/10.1155/2012/201754
Research Article

Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes

1Abdominal Transplantation, University of Arizona Medical Center, Tucson, AZ, USA
2Abdominal Transplantation, Department of Pharmacy, University of Arizona Medical Center, Tucson, AZ, USA
3University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA

Received 19 October 2011; Revised 4 November 2011; Accepted 28 December 2011

Academic Editor: Banu Sis

Copyright © 2011 Olivia R. Blume 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

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.