New insights in antibody-mediated rejection
| Autor: | Denis Glotz, Clément Gosset, Carmen Lefaucheur |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Graft Rejection
medicine.medical_specialty Allograft failure Banff Classification Biopsy Disease Kidney Graft loss Risk Assessment Unmet needs Isoantibodies Predictive Value of Tests Risk Factors Internal Medicine Animals Humans Medicine Kidney surgery Intensive care medicine business.industry Surrogate endpoint Graft Survival Complement System Proteins Kidney Transplantation Treatment Outcome Nephrology Antibody mediated rejection business |
| Zdroj: | Current Opinion in Nephrology and Hypertension. 23:597-604 |
| ISSN: | 1062-4821 |
| Popis: | Purpose of review In the present review, we aim to describe the state of knowledge concerning antibody-mediated rejection (ABMR) spectrum and diagnosis criteria before analyzing the present and future promising leads regarding ABMR prognosis markers and treatment. Recent findings Recent studies regarding complement-binding donor-specific antibodies and the molecular approach highlighted the unmet need for stratification tools for prognosis and treatment inside ABMR disease. Summary ABMR is the leading cause of kidney allograft failure. The recent expansion of its spectrum is related to the paradigm of a continuous process, leading insidiously to a chronic form of ABMR and to the progressive acknowledgement of new entities (such as vascular ABMR, subclinical ABMR, C4d-negative ABMR). Considering the global picture of ABMR, the Banff classification gradually refined the diagnosis criteria so that it now describes a clinically relevant and coherent entity. Nevertheless, if the diagnosis mainly relies on conventional assessment, such as histological findings and circulating donor-specific antibodies, these criteria face serious limitations in terms of stratification of patients at risk of graft loss inside ABMR disease. Recently, new promising tools have emerged in order to identify long-term outcomes at the time of the diagnosis of rejection. In this regard, donor-specific antibodies' complement-fixing ability and the molecular approach contributed significantly. Currently, however, no clinically relevant surrogate marker of treatment efficiency is currently available. |
| Databáze: | OpenAIRE |
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