Antibody-mediated Rejection in Kidney Transplant: An Unmastered Area

Abstract

Antibody-mediated rejection (ABMR) remains a significant cause of allograft failure in patients with kidney transplantation. Despite successful strategies to treat ABMR, irreversible injury in the form of transplant glomerulopathy commonly manifests months to years later. Treatment for ABMR is not standardized, and treatment guidelines vary among different transplant centers. The outcomes for patients at risk for ABMR have not significantly changed over the years. This is largely because of an incomplete understanding of the mechanisms of injury responsible for different phenotypes of ABMR. Establishing relevant surrogate endpoints to facilitate more informative studies will likely allow for a more accurate determination of prognosis and pave the way for new and effective therapeutic approaches. This article aims to summarize the current understanding of the mechanism of injury in ABMR and highlight current diagnostic approaches and treatment strategies.