Humoral Immunity in Kidney Transplantation

What Clinicians Need to Know

G. Remuzzi, S. Chiaramonte, N. Perico, C. Ronco, Claudio Ronco

• Publisher: S. Karger
• Year: 2009
• Print ISBN:
  9783805589451
• eBook ISBN:
  9783805589598
• Edition: 1
• Topic: Medicine
• Subtopic: Immunology

As recent advances in immunosuppression and apheresis techniques have opened new avenues for the management of humoral immunity, interest in ABO-incompatible kidney transplantation has been renewed. Moreover, new screening techniques - such as the single antigen bead assay - allow for the detection and definition of very low levels of alloantibody, which has had a positive impact on the treatment possibilities in highly sensitized adult patients with end-stage renal disease. But despite these advances, a theoretical rationale is still missing for both the decision to transplant a sensitized patient and the classification of the transplant as low, medium or high risk. There is also no uniform approach with regard to pre-transplant desensitization protocols, and it is unclear whether particular post-transplant immunosuppression will be required and what would be the best combination treatment. Last but not least, the frequency and actual clinical impact of alloantibodies developed after transplantation on short- and long-term graft survival need to be ascertained. Aimed especially at the clinician, this publication presents recent insights in the characterization and pathogenetic role of humoral immunity in chronic allograft injury and investigates the perspectives for novel immunosuppressive therapies to control antibody production after transplantation.

Table of contents

• cover
• Contents
• Preface
• Clinical Relevance of Preformed HLA Donor-Specific Antibodies in Kidney Transplantation
• Therapeutic Strategies in Management of the Highly HLA-Sensitized and ABO-Incompatible Transplant Recipients
• Posttransplant Immunosuppression in Highly Sensitized Patients
• Rapid Accomodation of an A1 Renal Allograft after Preconditioning for ABO-IncompatibleTransplantation
• ABO-Incompatible Kidney Transplantation with Antigen-Specific Immunoadsorption and Rituximab – Insights and Uncertainties
• Evaluation of Two Different Preconditioning Regimens for ABO-Incompatible Living Kidney Donor Transplantation
• Pathology of Chronic Humoral Rejection
• De novo Anti-HLA Antibody Responses after Renal Transplantation: Detection and Clinical Impact
• The Emerging Issue of MICA Antibodies: Antibodies to MICA and Other Antigens of Endothelial Cells
• Development of Non-Donor-Specific HLA Antibodies after Kidney Transplantation: Frequency and Clinical Implications
• Control of Anti-Donor Antibody Production Post-Transplantation: Conventional and Novel Immunosuppressive Therapies
• Non-HLA Antibodies Post-Transplantation: Clinical Relevance and Treatment in Solid Organ Transplantation
• Author Index
• Subject Index