Antibody-mediated rejection (AMR) is a relatively rare but severe complication in kidney transplantation associated with increased risk of graft loss. Diagnosis of acute and chronic AMR is based on typical histological hallmarks, deposition of C4d in peritubular capillaries and presence of donor-specific antibodies (DSA). Many novel and attractive treatment options have become available in recent years: antibody removal and production inhibition (plasmapheresis, IVIg), B cell depletion (rituximab), plasma cell depletion and apoptosis (bortezomib), and complement activation inhibition (eculizumab). Standard therapy is based on PP and IVIg. Preliminary results with new agents are encouraging but require randomised clinical trials and long-term follow-up.
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