Chronic Active T-Cell Mediated Kidney Rejection as a Clinically Significant Type of Allograft Loss?

Abstract

The purpose of this article is to assess the present knowledge about chronic active (CA) T-cell mediated rejection (TCMR) of a kidney. In the research authors review current Banff diagnostic criteria used in kidney rejection, focus on their possible future evolution, and investigate the role of currently available molecular methods that could be implemented into the diagnostic scheme. Research also points out previously and currently available treatment methods applied to CA TCMR and takes into account possible side effects consequent upon the therapy. Moreover, attention is being paid to the CA TCMR coincidence with other kidney rejection types such as antibody-mediated rejection (ABMR) and its influence on the treatment approach. Authors also mark the possibility of non-HLA antibodies coexistence in patients with CA TCMR and describe its possible resonance on kidney allograft function. Nonetheless, it seems that current knowledge about CA TCMR is not sufficient and requires further investigation.

Indoleamine 2,3-Dioxygenase 1 (IDO1) in Kidney Transplantation: A Guardian against Rejection

“…This local expression of IDO1 can contribute to creating an immunosuppressive micro-environment within the transplanted organ. This immunosuppressive environment is believed to be beneficial for promoting graft tolerance and reducing the risk of rejection [29,62]. Given IDO1's role in immune regulation and its potential as both a marker for rejection and an immunosuppressive factor, researchers have explored IDO1-targeted therapies for improving cancer outcomes [63][64][65][66][67][68].…”

Therapy in the Course of Kidney Graft Rejection—Implications for the Cardiovascular System—A Systematic Review

“…As CA TCMR is a newly described term, there is a lack of clear guidelines for the management of the ailment. Studies have shown that some researchers hesitate whether CA TCMR should be treated or even diagnosed [49]. In 2017, more than 90% of cooperating clinical centers diagnosed CA TCMR and treated the ailment with immunosuppressive medications including steroids in more than 80% of cases.…”

“…There is still a need for large, randomized studies where patients would be treated with different immunosuppressive agents and combinations of those medications to work out an ideal scheme for CA TCMR treatment. Even though some clinical research has already been conducted, the results are questionable and uncertain [49].…”