PMID- 33901113
OWN - NLM
STAT- MEDLINE
DCOM- 20220331
LR  - 20220401
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 105
IP  - 11
DP  - 2021 Nov 1
TI  - Histologic Antibody-mediated Kidney Allograft Rejection in the Absence of 
      Donor-specific HLA Antibodies.
PG  - e181-e190
LID - 10.1097/TP.0000000000003797 [doi]
AB  - Histologic antibody-mediated rejection (hAMR) is defined as a kidney allograft 
      biopsy satisfying the first 2 Banff criteria for diagnosing AMR: tissue injury 
      and evidence of current/recent antibody interaction with the endothelium. In 
      approximately one-half of such cases, circulating human leukocyte antigen (HLA) 
      donor-specific antibodies (DSA) are not detectable by current methodology at the 
      time of biopsy. Some studies indicated a better prognosis for HLA-DSA-negative 
      cases of hAMR compared to those with detectable HLA-DSA, whereas others found 
      equally poor survival compared to hAMR-negative cases. We reviewed the literature 
      regarding the pathophysiology of HLA-DSA-negative hAMR. We find 3 nonmutually 
      exclusive possibilities: (1) HLA-DSA are involved, but just not detected; (2) 
      non-HLA-DSA (allo or autoantibodies) are pathogenically involved; and/or (3) 
      antibody-independent NK cell activation is mediating the process through 
      "missing-self" or other activating mechanisms. These possibilities are discussed 
      in detail. Recommendations regarding the approach to such patients are made. 
      Clearly, more research is necessary regarding the measurement of non-HLA 
      antibodies, recipient/donor NK cell genotyping, and the use of antibody reduction 
      therapy or other immunosuppression in any subset of patients with 
      HLA-DSA-negative hAMR.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Filippone, Edward J
AU  - Filippone EJ
AD  - Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at 
      Thomas Jefferson University, Philadelphia, PA.
FAU - Farber, John L
AU  - Farber JL
AD  - Department of Pathology, Sidney Kimmel Medical College at Thomas Jefferson 
      University, Philadelphia, PA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (Autoantibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Allografts
MH  - Autoantibodies
MH  - *Graft Rejection
MH  - HLA Antigens
MH  - Humans
MH  - Isoantibodies
MH  - Kidney/pathology
MH  - *Kidney Transplantation/adverse effects
MH  - Tissue Donors
COIS- The authors declare no funding or conflicts of interest.
EDAT- 2021/04/27 06:00
MHDA- 2022/04/01 06:00
CRDT- 2021/04/26 17:18
PHST- 2021/04/27 06:00 [pubmed]
PHST- 2022/04/01 06:00 [medline]
PHST- 2021/04/26 17:18 [entrez]
AID - 00007890-202111000-00017 [pii]
AID - 10.1097/TP.0000000000003797 [doi]
PST - ppublish
SO  - Transplantation. 2021 Nov 1;105(11):e181-e190. doi: 10.1097/TP.0000000000003797.