Current Therapies in Kidney Transplant Rejection
This review outlines how clinicians currently diagnose and treat the two main forms of kidney-transplant rejection, T-cell-mediated and antibody-mediated, and underscores that many antibody-mediated rejection treatments still have questionable efficacy, leaving optimized immunosuppression and adherence central to management.
Background
Despite significant advances in immunosuppressive therapies, kidney-transplant rejection continues to threaten long-term graft survival. Rejection is broadly divided into acute T-cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR), both diagnosed by histological examination of kidney biopsy samples.
Key findings
Corticosteroids are the primary treatment for TCMR, while severe or steroid-resistant cases may require T-cell-depleting agents such as thymoglobulin. ABMR is most commonly treated with plasmapheresis, though its efficacy is debated; intravenous immunoglobulins, anti-CD20 antibodies, complement inhibitors, and proteasome inhibitors are also used to varying degrees, but their efficacy remains questionable.
Clinical implications
Management of both TCMR and ABMR depends on the timing of the rejection episode and the presence of chronic changes; optimizing immunosuppression and addressing adherence are crucial, and further research into newer therapeutics is needed.
Category
Transplant
Source
Journal of Clinical Medicine
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