Management of antibody-mediated rejection in transplantation

Surg Clin North Am. 2013 Dec;93(6):1451-66. doi: 10.1016/j.suc.2013.08.002. Epub 2013 Sep 29.

Abstract

Despite intensive traditional immunosuppressive therapy, rates of graft loss have approximated 15% to 20% at 1 year following antibody-mediated rejection (AMR) in solid organ transplant recipients. Therefore, the development of antihumoral therapies that provide prompt elimination of donor-specific anti-HLA antibodies and improve allograft survival is an important goal. Traditional treatment modalities for AMR deplete B-cell populations but not the cell at the source of antibody production, the mature plasma cell. Plasma cell-targeted therapies using proteasome inhibition is a novel approach to treating AMR. This review discusses current and emerging treatment modalities used for AMR.

Keywords: Antibody-mediated rejection; Donor-specific antibodies; Kidney transplantation; Plasma cell.

Publication types

  • Review

MeSH terms

  • Antibodies / immunology*
  • Antibodies, Monoclonal, Humanized / pharmacology
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Boronic Acids / pharmacology
  • Boronic Acids / therapeutic use
  • Bortezomib
  • Graft Rejection / immunology*
  • Humans
  • Immunoglobulins, Intravenous / pharmacology
  • Immunologic Factors / pharmacology
  • Immunosorbent Techniques
  • Kidney Transplantation*
  • Plasma Cells / drug effects
  • Plasmapheresis
  • Pyrazines / pharmacology
  • Pyrazines / therapeutic use
  • Rituximab
  • Splenectomy

Substances

  • Antibodies
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Monoclonal, Murine-Derived
  • Boronic Acids
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Pyrazines
  • Rituximab
  • Bortezomib
  • eculizumab