New insights in antibody-mediated rejection

Area of Science:

• Nephrology
• Transplant Immunology
• Pathology

Background:

• Antibody-mediated rejection (ABMR) is the leading cause of kidney allograft failure.
• The spectrum of ABMR has expanded, recognizing new entities like vascular, subclinical, and C4d-negative ABMR.
• The Banff classification has refined ABMR diagnosis, but limitations exist for patient stratification.

Purpose of the Study:

• To review the current knowledge on the ABMR spectrum and diagnostic criteria.
• To analyze existing and emerging prognostic markers for ABMR.
• To discuss current and future treatment strategies for ABMR.

Main Methods:

• Literature review focusing on recent studies and advancements in ABMR.
• Analysis of diagnostic criteria and their limitations.
• Evaluation of novel prognostic tools and therapeutic approaches.

Main Results:

• Recent studies highlight the need for stratification tools for prognosis and treatment in ABMR.
• Complement-binding donor-specific antibodies and molecular approaches show promise.
• Current diagnostic criteria have limitations in predicting graft loss risk.

Conclusions:

• ABMR diagnosis relies on histology and donor-specific antibodies but lacks robust stratification.
• New tools like complement-fixing ability and molecular profiling aid in outcome prediction.
• There is a current lack of clinically relevant surrogate markers for treatment efficiency in ABMR.