With a better understanding of the Histocompatibility and the development of immunosuppressive drug, the incidence of acute rejection after kidney transplantation has decreased significantly, and the short-term survival rate of kidney transplantation has increased significantly. The long-term survival rate of kidney transplants has also improved, but it is far from satisfactory.
Relationship between antibody-mediated and renal transplantation
In addition to t cell-mediated rejection, antibody-mediated rejection also plays an important role in renal allograft dysfunction. Moreover, antibody-mediated rejection has been recognized as the most important barrier to long-term renal allograft survival.
Antibody-mediated rejection after kidney transplantation is a type of rejection that is mainly mediated by anti-donor specific antibodies in the recipient.
It has been reported that antibody-mediated rejection accounts for about 50% of all rejections and often coexists with cell-mediated rejection. More than half of allograft loss is associated with antibody-mediated rejection.
The development of antibody-mediated rejection
Although the negative effects of antibody-mediated rejection on graft function and prognosis are well recognized, its definitive diagnosis and effective treatment remain a challenge.
The diagnostic criteria for antibody-mediated rejection have evolved, and new types of antibody-mediated rejection have been discovered.
It has been redefined in the latest 2013 Banff classification, and C4d-negative antibody-mediated rejection has been newly classified. Histological evidence, donor-specific antibodies and vascular endothelial injury are the three criteria for the diagnosis. Among them, donor-specific antibody, also known as DSA, is the hottest research direction in recent years, and is also considered to be the culprit of antibody-mediated rejection.
Dr. Zhu recommends:
Since there are currently no effective drugs to treat antibody-mediated rejection, regular DSA monitoring after kidney transplantation is important to detect antibody-mediated rejection as early as possible.
Therefore, it is important to pay attention to the monitoring of DSA one week, one month, three months, six months, and every six months after kidney transplantation, and to adjust the immunosuppressive regimen in time according to the results, extend the life span of transplanted kidney and protect our health!
Article, edited | Zhu Dong, photography | Qian Zixin
