Antibody-Mediated Rejection in Kidney Transplantation

─ Current Diagnosis and its Treatment ─ Up to Date

Abstract

In contrast to acute cellular rejection, kidney transplant rejection involving anti-HLA antibody is a high-risk clinical condition that is always associated with the possibility of a tragic outcome, such as graft loss. Graft biopsy may reveal diffuse C4d deposition in peritubular capillaries, renal tubulitis, or glomerulitis, and anti-donor antibody may be detected in the patient’s serum. The treatment strategy consists of removing the anti-HLA antibody and suppressing antibody production. Specific current treatment options include plasmapheresis/plasma exchange therapy (immunoadsorption), tacrolimus therapy, mycophenolate mofetil therapy, high-dose gamma-globulin therapy, anti-CD20 antibody (rituximab), and splenectomy. Although the combinations of these treatments and the doses used differ from center to center, treatment results in conversions to a negative response (desensitization) in cross-match-positive patients, thereby allowing successful transplantation. High-dose gamma-globulin therapy for the treatment of antibody-mediated rejection has also been covered by national insurance in September/2024. In this session, it is great pleasure to be given an opportunity to describe pathology of antibody mediated rejection after kidney transplantation, diagnostic criteria of antibody-mediated rejection on the basis of Banff 2022, and current trend for treatment of antibody-mediated rejection.