Antibody-Mediated Rejection in Kidney Transplantation

Dear Colleagues,

Antibody-mediated rejection (AMR) represent a major challenge in kidney transplantation, affecting both the short- and long-term survival of grafts since it was discovered in the context of hyperacute rejection in the 1960s. The significant role that donor-specific antibodies (DSA) play in AMR, along with the deposition of the complement coponent C4d, was identified in the 1990s.

Although the advent of solid-phase assays and flow cytometry crossmatch has enabled the more precise detection of DSAs, challenges related to the development of optimal surveillance protocols for the early detection of subclinical AMR remain, as well as challenges regarding the elucidatation of the pathogenicity of non-HLA antibodies and anti-blood-type antibodies.

The treatments traditionally employed to remedy AMR include steroids, plasmapheresis, and intravenous immunoglobulin, later supplemented by B-cell depletion. Treatment options have expanded to include monoclonal antibodies targeting CD25, CD20 and C5. Additional approaches targeting other molecules in the immune system are also expected to emerge. Despite these advancements, chronic AMR remains a leading cause of late graft failure. Therefore, effective desensitization strategies or interventions are required to halt its insidious progression.

We welcome scientists and clinicians to contribute to this Special Issue of Antibodies, which aims to redefine the management of AMR in kidney transplantation and enhance the treatment of patients.

Dr. Kazuhiro Iwadoh
Prof. Dr. Hiroto Egawa
Guest Editors

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