PMID- 15910400
OWN - NLM
STAT- MEDLINE
DCOM- 20050901
LR  - 20201215
IS  - 1397-3142 (Print)
IS  - 1397-3142 (Linking)
VI  - 9
IP  - 3
DP  - 2005 Jun
TI  - Current approaches to treatment of antibody-mediated rejection.
PG  - 408-15
AB  - Antibody-mediated rejection (AMR) has recently been recognized as a significant 
      and unique form of rejection that is not amenable to treatment with standard 
      immunosuppressive medications aimed at modification of T-cell function. Recent 
      interest in AMR and the role of B cells in rejection has been aided by the 
      concomitant discovery that C4d staining of renal biopsy tissue is strongly 
      associated with AMR and a poor prognosis, and the emergence of desensitization 
      protocols for treatment of highly human leukocyte antigen (HLA)-sensitized 
      patients. Treatment options include: (i) the use of high-dose intravenous 
      immunoglobulin (IVIG) which works by blocking anti-HLA antibody activity and 
      through complement inhibition, (ii) the use of Rituxan (anti-CD20 chimeric 
      antibody) to deplete B cells and interfere with antigen-presenting cell (APC) 
      activity of B cells subsequently decreasing T-cell activation, and (iii) the use 
      of plasmapheresis (PE) + anti-cytomegalovirus (CMV) immunoglobulin G (IgG) or 
      IVIG in lower doses. This protocol removes deleterious anti-HLA antibodies and 
      may also allow complexing of anti-HLA with anti-idiotypes in the anti-CMV IgG. 
      Although early, data support the efficacy of all three approaches. Many centers 
      are now designing protocols that utilize a combination of all three agents. In 
      summary, recent advances in the diagnosis and treatment of AMR has allowed for 
      significant improvements in outcomes of a condition usually associated with rapid 
      graft failure. However, much work needs to be done to better understand the 
      immunologic processes leading to AMR and how current therapies can be best used 
      to effectively prevent and treat it.
FAU - Jordan, Stanley C
AU  - Jordan SC
AD  - Renal Transplant Program, Cedars-Sinai Medical Center, UCLA School of Medicine, 
      Los Angeles, CA 90048, USA. sjordan@cshs.org
FAU - Vo, Ashley A
AU  - Vo AA
FAU - Tyan, Dolly
AU  - Tyan D
FAU - Nast, Cynthia C
AU  - Nast CC
FAU - Toyoda, Mieko
AU  - Toyoda M
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Denmark
TA  - Pediatr Transplant
JT  - Pediatric transplantation
JID - 9802574
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
RN  - 4F4X42SYQ6 (Rituximab)
SB  - IM
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Antibodies, Monoclonal, Murine-Derived
MH  - Antibody Specificity
MH  - B-Lymphocytes/immunology
MH  - Graft Rejection/drug therapy/*immunology/pathology/*therapy
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Immunologic Factors/therapeutic use
MH  - Kidney Transplantation
MH  - Lymphocyte Culture Test, Mixed
MH  - Plasmapheresis
MH  - Rituximab
MH  - T-Lymphocytes/immunology
RF  - 50
EDAT- 2005/05/25 09:00
MHDA- 2005/09/02 09:00
CRDT- 2005/05/25 09:00
PHST- 2005/05/25 09:00 [pubmed]
PHST- 2005/09/02 09:00 [medline]
PHST- 2005/05/25 09:00 [entrez]
AID - PTR363 [pii]
AID - 10.1111/j.1399-3046.2005.00363.x [doi]
PST - ppublish
SO  - Pediatr Transplant. 2005 Jun;9(3):408-15. doi: 10.1111/j.1399-3046.2005.00363.x.