T-cell-mediated rejection of the kidney in the era of donor-specific antibodies: diagnostic challenges and clinical significance.

Abstract:

PURPOSE OF REVIEW:Burgeoning literature on antibody-mediated rejection (ABMR) has led to a perception that T-cell-mediated rejection (TCMR) is no longer a significant problem. This premise needs to be carefully appraised. RECENT FINDINGS:A review of the literature indicates that TCMR remains an independent-risk factor for graft loss. Importantly, it can occur as a sensitizing event that triggers ABMR, and adversely affects its outcome. Moreover, T cells are regularly present in lesions used to diagnose ABMR, and these lesions can also develop in the absence of donor-specific antibodies (DSA). Conversely, patients with DSA are at risk for mixed ABMR-TCMR, which is quite common in many studies, and may require a combined anti-T-cell and anti-B-cell strategy for the best outcome. SUMMARY:T-cell-based clinical monitoring and therapy is still relevant for prophylaxis of both cellular and humoral rejection, treatment of steroid refractory TCMR, which occurs in up to 20% of patients, and optimization of clinical outcome in mixed TCMR-ABMR, which is more frequently encountered than generally appreciated, and still associated with unacceptably high rates of graft loss.

authors

Randhawa P

doi

10.1097/MOT.0000000000000189

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

325-32

issue

3

eissn

1087-2418

issn

1531-7013

journal_volume

20

pub_type

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