Diagnosis and treatment of antibody-mediated kidney allograft rejection

被引:47
作者
Böhmig, G
Regele, H
机构
[1] Univ Vienna, AKH, Clin Inst Pathol, A-1090 Vienna, Austria
[2] Univ Vienna, Dept Internal Med 3, Div Nephrol & Dialysis, Vienna, Austria
关键词
antibody-mediated rejection; apheresis; C4d; immunoadsorption; kidney; transplantation;
D O I
10.1111/j.1432-2277.2003.tb00241.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Evidence of a significant pathogenetic role of donor-reactive antibodies (DRA) in kidney allograft rejection is accumulating. At least, partially owing to the recent discovery of the complement split product C4d as a valuable rejection marker, antibody-mediated rejection (AMR) has regained increasing attention. We review here the value of various diagnostic criteria, including immunohistochemistry (C4d staining), histomorphology and posttransplant serology, for the diagnosis of AMR. Furthermore, the mechanisms underlying alloantibody/complement-mediated allograft injury are discussed in detail. Finally, a thorough discussion of recently proposed "anti-humoral" therapeutic strategies is provided.
引用
收藏
页码:773 / 787
页数:15
相关论文
共 121 条
  • [71] Mauiyyedi S, 2001, J AM SOC NEPHROL, V12, P574, DOI 10.1681/ASN.V123574
  • [72] Anti-HLA antibodies after solid organ transplantation
    McKenna, RM
    Takemoto, SK
    Terasaki, PI
    [J]. TRANSPLANTATION, 2000, 69 (03) : 319 - 326
  • [73] MONGA G, 1992, MODERN PATHOL, V5, P125
  • [74] Identification of patients at high risk of graft loss by pre- and posttransplant monitoring of anti-HLA class I IgG antibodies by enzyme-linked immunosorbent assay
    Monteiro, F
    Buelow, R
    Mineiro, C
    Rodrigues, H
    Kalil, J
    [J]. TRANSPLANTATION, 1997, 63 (04) : 542 - 546
  • [75] Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match-positive recipients
    Montgomery, RA
    Zachary, AA
    Racusen, LC
    Leffell, MS
    King, KE
    Burdick, J
    Maley, WR
    Ratner, LE
    [J]. TRANSPLANTATION, 2000, 70 (06) : 887 - 895
  • [76] Membrane attack complex contributes to destruction of vascular integrity in acute lung allograft rejection
    Nakashima, S
    Qian, ZP
    Rahimi, S
    Wasowska, BA
    Baldwin, WM
    [J]. JOURNAL OF IMMUNOLOGY, 2002, 169 (08) : 4620 - 4627
  • [77] Nickeleit V, 2002, J AM SOC NEPHROL, V13, P242, DOI 10.1681/ASN.V131242
  • [78] OPELZ G, 1992, TRANSPLANT P, V24, P2342
  • [79] Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation
    Pascual, M
    Saidman, S
    Tolkoff-Rubin, N
    Williams, WW
    Mauiyyedi, S
    Duan, JM
    Farrell, ML
    Colvin, RB
    Cosimi, AB
    Delmonico, FL
    [J]. TRANSPLANTATION, 1998, 66 (11) : 1460 - 1464
  • [80] SIGNIFICANCE OF POSITIVE CROSSMATCH TEST IN KIDNEY TRANSPLANTATION
    PATEL, R
    TERASAKI, PI
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1969, 280 (14) : 735 - &