Early Diagnosis and Treatment of Subclinical AMR Is Vital for Improving Clinical Outcomes

摘要

Despite remarkable improvements in short-term outcomes of kidney grafts over the last decade, long-term outcomes have not significantly changed. About one-third of all transplanted patients will lose their graft within 10 years. We now know that the majority of late allograft loss results from cumulative effects of underlying subacute immunological injury and that such processes often remain undetected until irreversible damage has already occurred. Late irreversible graft failure is typically associated with antibody-mediated responses, which are now the greatest unsolved problem in improving kidney transplant outcomes. None of the current treatment options for clinical antibody-mediated rejection (AMR) (including steroids, plasmapheresis, application of IVIGs or rituximab) have been able to significantly improve outcomes; therefore, new diagnostic and therapeutic strategies are urgently needed.