October 28, 2024, Immune Tolerance
With improved understanding of histocompatibility and advancements in immunosuppressive medications, the incidence of acute rejection following kidney transplantation has significantly decreased, and the short-term survival rate of kidney transplants has markedly improved. The long-term survival rate of kidney transplants has also improved, but it remains far from satisfactory.
The Relationship Between Antibody-Mediated Rejection and Kidney Transplantation
In addition to T cell-mediated rejection, antibody-mediated rejection plays a critical role in kidney allograft dysfunction. Furthermore, antibody-mediated rejection is widely recognized as the primary barrier to long-term kidney allograft survival.
Antibody-mediated rejection following kidney transplantation is a type of rejection primarily driven by anti-donor-specific antibodies in the recipient.
Reports indicate that antibody-mediated rejection constitutes approximately 50% of all rejections and frequently co-occurs with cell-mediated rejection. More than half of allograft losses are linked to antibody-mediated rejection.
The Progression of Antibody-Mediated Rejection
Although the adverse effects of antibody-mediated rejection on graft function and prognosis are well acknowledged, achieving a definitive diagnosis and effective treatment remains challenging.
The diagnostic criteria for antibody-mediated rejection have evolved, and new subtypes of this rejection have been identified.
It has been redefined in the latest 2013 Banff classification, with C4d-negative antibody-mediated rejection newly categorized. Histological evidence, donor-specific antibodies, and vascular endothelial injury constitute the three diagnostic criteria. Among these, donor-specific antibodies, also known as DSAs, have become a leading research focus in recent years and are considered the primary cause of antibody-mediated rejection.
Dr. Zhu’s Recommendations:
Given the current lack of effective drugs to treat antibody-mediated rejection, regular DSA monitoring after kidney transplantation is crucial for detecting this type of rejection as early as possible.
Therefore, it is essential to monitor DSAs at one week, one month, three months, six months, and every six months following kidney transplantation, adjusting the immunosuppressive regimen promptly based on the results to extend the lifespan of the transplanted kidney and safeguard our health!
Written by | Zhu Dong, Edited by | Zhu Dong, Photography | Qian Zixin
