The role of antibodies in transplantation

Abstract

For the past forty years T-cells have been considered the primary threat to the survival of allografts. However antibodies can induce severe vascular disease of organ transplants and this disease, particularly "antibody-mediated" rejection, has become a major clinical challenge. Not only do antibodies cause rejection, the rejection caused by antibodies resists treatment by conventional drug regimens. On the other hand, antibodies can induce a condition in which grafts seemingly resist antibody-mediated injury, which is accommodation. In this communication we discuss the role of antibodies in the diagnosis and pathogenesis of rejection and accommodation, and suggest what we consider the major gaps in knowledge and directions research into this subject might productively take.

Evaluation of CTLA-4, CD28 and CD86 Genes Polymorphisms in Acute Renal Allograft Rejection among Tunisian Patients

“…In our study, sensitized patients were statistically more susceptible to develop acute rejection than non-sensitized ones. This result corroborates those of previous studies which reported that patients with pre-transplantation high levels of panel-reactive antibody show an increased risk of graft failure (Chang et al, 2009;Karahan et al, 2009). A recent analysis in end-stage renal disease patients among Turkish population proposed also that de novo synthesis of these antibodies after transplantation could be detrimental for the graft.…”

“…It is also established that pre-formed anti-HLA antibodies in allograft recipients can induce sever vascular disease of organ transplant, particularly an antibody-mediated rejection (humoral rejection), which has become a major clinical challenge since the rejection caused by antibodies resists treatment by conventional drug regimens. In renal transplant, hyper acute rejection is the most often caused by anti-HLA antibodies produced by the graft recipient (Chang et al, 2009;Poli, 2009). Moreover, donor-specific anti-HLA antibodies developed after transplantation transduce signals that are both pro-inflammatory than proproliferative suggesting mechanistic roles in acute and chronic antibody-mediated rejection (Li et al, 2009).…”

Effective Therapy for Acute Antibody-Mediated Rejection With Mild Chronic Changes: Case Report and Review of the Literature

“…Although antibodies specific for the donor are sometimes found in the circulation, such antibodies are not often found, at least not at high levels. 7 In contrast to prior reports suggesting that rituximab leads to decreased serum alloantibody levels in sensitized recipients, 8 we contend that accumulating data suggest that rituximab likely plays little beneficial role in preventing ongoing antibody production in sensitized renal allograft candidates.…”

Pre- and posttransplantation allosensitization in heart allograft recipients: Major impact of de novo alloantibody production on allograft survival

“…It is axiomatic that if the antibodies are not fixing complement and are not cytolytic, they may not be harmful to the graft and may in fact play a protective role contributing to graft adaptation [38,39].…”