T-cell-mediated rejection of the kidney in the era of donor-specific antibodies: diagnostic challenges and clinical significance

Curr Opin Organ Transplant. 2015 Jun;20(3):325-32. doi: 10.1097/MOT.0000000000000189.

Abstract

Purpose of review: Burgeoning literature on antibody-mediated rejection (ABMR) has led to a perception that T-cell-mediated rejection (TCMR) is no longer a significant problem. This premise needs to be carefully appraised.

Recent findings: A review of the literature indicates that TCMR remains an independent-risk factor for graft loss. Importantly, it can occur as a sensitizing event that triggers ABMR, and adversely affects its outcome. Moreover, T cells are regularly present in lesions used to diagnose ABMR, and these lesions can also develop in the absence of donor-specific antibodies (DSA). Conversely, patients with DSA are at risk for mixed ABMR-TCMR, which is quite common in many studies, and may require a combined anti-T-cell and anti-B-cell strategy for the best outcome.

Summary: T-cell-based clinical monitoring and therapy is still relevant for prophylaxis of both cellular and humoral rejection, treatment of steroid refractory TCMR, which occurs in up to 20% of patients, and optimization of clinical outcome in mixed TCMR-ABMR, which is more frequently encountered than generally appreciated, and still associated with unacceptably high rates of graft loss.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies / immunology*
  • Graft Rejection / immunology*
  • Humans
  • Kidney Transplantation / adverse effects*
  • T-Lymphocytes / immunology*
  • Tissue Donors

Substances

  • Antibodies