Antibody-Mediated Rejection in Kidney Transplantation

Abstract

Introduction: Antibody-mediated rejection (AMR) is a major cause of graft loss despite improved immunosuppression. Methods: Literature review of 40 studies on diagnosis (donor-specific antibodies, C4d staining), pathophysiology, and treatment of AMR. Results: AMR occurs in 10–20% of recipients, more common in sensitized patients. Treatment options include plasmapheresis, IVIG, rituximab, and bortezomib, with response rates 40–70%. Eculizumab for refractory AMR showed promise in small series. Discussion: Chronic AMR leads to transplant glomerulopathy and fibrosis. Conclusion: Early diagnosis and novel anti-humoral therapies are critical to preserving graft function.