PMID- 26348571
OWN - NLM
STAT- MEDLINE
DCOM- 20160208
LR  - 20181202
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 20
IP  - 5
DP  - 2015 Oct
TI  - Antibody-mediated rejection.
PG  - 536-42
LID - 10.1097/MOT.0000000000000230 [doi]
AB  - PURPOSE OF REVIEW: Over the last five decades, the attention of nephrologists has 
      focused on cellular rejection which was considered to be responsible for the 
      early loss of function of the transplanted kidney. The use of new drugs in 
      different combinations with steroids resulted in an improved short-term survival 
      of the graft, which has significantly reduced the incidence of acute rejections. 
      The main problem now, however, is ensuring the long-term survival of the 
      transplanted kidney. This has become the challenge of the new millennium. RECENT 
      FINDINGS: The current literature clearly focuses on donor-specific 
      alloantibodies, directed against human leukocyte antigen (HLA) and non-HLA 
      antigens [donor-specific antibodies (DSA)], which have been shown to play an 
      important role in graft dysfunction, longevity, and loss. To mitigate allograft 
      loss due to antibodies, it is important to treat the source of antibody 
      production, the plasma cells. Drugs used prior to 2007, such as Rituximab, 
      intravenous immunoglobulins, and plasmapheresis, lack effects on these long-lived 
      plasma cells. Their ability to remove DSA is incomplete and/or cost prohibitive. 
      Since 2007, Bortezomib, a proteasome inhibitor, has been used to deplete plasma 
      cells, thus eliminating the synthesis of DSA. SUMMARY: Antibody-mediated 
      rejection (AMR) is common in patients with DSA and is associated with a poor 
      prognosis. Novel medications that target each step of AMR pathogenesis have been 
      produced and are successful when compared with more traditional therapies.
FAU - Amore, Alessandro
AU  - Amore A
AD  - Department of Nephrology, Regina Margherita University Hospital, Azienda 
      Ospedaliera Universitaria, Citta della Salute e della Scienza, Torino, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (Histocompatibility Antigens Class I)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Antibody Specificity
MH  - Graft Rejection/*immunology
MH  - Histocompatibility Antigens Class I/immunology
MH  - Humans
MH  - Isoantibodies/*immunology
MH  - Prognosis
MH  - Transplantation, Homologous
EDAT- 2015/09/09 06:00
MHDA- 2016/02/09 06:00
CRDT- 2015/09/09 06:00
PHST- 2015/09/09 06:00 [entrez]
PHST- 2015/09/09 06:00 [pubmed]
PHST- 2016/02/09 06:00 [medline]
AID - 00075200-201510000-00009 [pii]
AID - 10.1097/MOT.0000000000000230 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2015 Oct;20(5):536-42. doi: 
      10.1097/MOT.0000000000000230.