Antibody-Mediated Rejection Pathogenesis, Prevention, Treatment, and Outcomes.pdfVIP

Hindawi Publishing Corporation Journal of Transplantation Volume 2012, Article ID 201754, 7 pages doi:10.1155/2012/201754 Research Article Antibody-Mediated Rejection: Pathogenesis, Prevention, Treatment, and Outcomes Olivia R. Blume,1 Sarah E. Yost,2 and Bruce Kaplan3 1Abdominal Transplantation, University of Arizona Medical Center, Tucson, AZ, USA 2 Abdominal Transplantation, Department of Pharmacy, University of Arizona Medical Center, Tucson, AZ, USA 3 University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA Correspondence should be addressed to Olivia R. Blume, olivia.blume@ Received 19 October 2011; Revised 4 November 2011; Accepted 28 December 2011 Academic Editor: Banu Sis Copyright © 2012 Olivia R. Blume et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Antibody-mediated rejection (AMR) is a major cause of late kidney transplant failure. It is important to have an understanding of human-leukocyte antigen (HLA) typing including well-designed studies to determine anti-MHC-class-I-related chain A (MICA) and antibody rejection pathogenesis. This can allow for more specific diagnosis and treatment which may improve long-term graft function. HLA-specific antibody detection prior to transplantation allows one to help determine the risk for AMR while detection of DSA along with a biopsy confirms it. It is now appreciated that biopsy for AMR does not have to include diffuse C4d, but does require a closer look at peritubular capillary microvasculature. Although plasmapheresis (PP) is effective in removing alloantibodies (DSAs) from the circulation,