Clinical and experimental aspects of renal allograft rejection

The pathophysiology, differential diagnosis, and clinical management of renal allograft rejection is reviewed. Recent data have revealed the discriminant biochemical and functional attributes of Class I (HLA-A,B, and C) and Class II (HLA-DR) major transplantation antigens. Graft rejection is an intricate process in which several cytodestructive mechanisms may coexist. The role of donor-specific and nonspecific immunologic monitoring tests in patient management is reviewed. Acute cellular rejection is usually readily reversed by high dose corticosteroid therapy while chronic humoral rejection is refractory to such treatment. Treatment of steroid-resistant rejection episodes by plasmapheresis/antilymphocyte globulin is under investigation.