Antibody-Mediated Rejection in Kidney Transplantation A Review英文文献资料.docVIP

HindawiPublishingCorporation JournalofTransplantation Volume2012,ArticleID193724,9pages doi:10.1155/2012/193724 ReviewArticle Antibody-MediatedRejectionin KidneyTransplantation:AReview ChethanPuttarajappa, RonShapiro, andHenkieP.Tan 1 2 2 1 2 Renal-ElectrolyteDivision,DepartmentofMedicine,UniversityofPittsburghMedicalCenter,Pittsburgh,PA15213-2582,USA DivisionofTransplantation,DepartmentofSurgery,UniversityofPittsburghMedicalCenter,Pittsburgh,PA15213-2582,USA CorrespondenceshouldbeaddressedtoHenkieP.Tan,tanhp@ Received22October2011;Accepted9January2012 AcademicEditor:EnverAkalin Copyright?2012ChethanPuttarajappaetal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttribution License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly cited. Antibodymediatedrejection(AMR)posesasigni?cantandcontinuedchallengeforlongtermgraftsurvivalinkidneytrans- plantation. However, in the recent years, there has emerged an increased understanding of the varied manifestations of the antibodymediatedprocessesinkidneytransplantation.Inthisarticle,webrie?ydiscussthevarioushistopathologicalandclinical manifestationsofAMRs,alongwithdescribingthetechniquesandmethodswhichhavemadeiteasiertode?neanddiagnosethese rejections.WealsoreviewtheemergingissuesofC4dnegativeAMR,itssigni?canceinlongtermallograftsurvivalandprovidea briefsummaryofthecurrentmanagementstrategiesformanagingAMRsinkidneytransplantation. 1.Introduction severeendothelialandarterialinjurymanifestedasarteritis (often transmural), interstitial edema, and severe cortical necrosis,withalmostallcasesrequiringallograftnephrecto- my.Mostoftheinitialcaseswerereportedinpatientswith a history of previous transplantation or in multiparous women,suggestingtheroleofsensitizationandpreformed antibodies. Strong proof for this was provided by Patel and Terasaki in 1969 when they showed that 24 of the 30 patients with a pretransplant positive crossmatch