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Antibodies
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Antibody-Mediated Rejection in Kidney Transplantation
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Antibody-Mediated Rejection in Kidney Transplantation

A special issue of Antibodies (ISSN 2073-4468). This special issue belongs to the section "Humoral Immunity".

Deadline for manuscript submissions: 25 June 2026 | Viewed by 11531

Special Issue Editors

Dr. Kazuhiro Iwadoh

E-Mail Website
Guest Editor
Department of Transplant Surgery, Mita Hospital, International University of Health and Welfare, Tokyo 108-8329, Japan
Interests: transplantation; biology; C1q; antibody-mediated rejection; risk analysis
Prof. Dr. Hiroto Egawa

E-Mail Website
Guest Editor
Department of Surgery, Hamamatsu Rosai Hospital, Hamamatsu 430-8525, Shizuoka, Japan
Interests: liver transplantation; solid organ transplant; liver surgery; immunosuppressive therapy; post-vaccination antibody

Special Issue Information

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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibodies is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • AMR treatment
  • anti-blood type antibodies
  • antibody-mediated rejection (AMR)
  • C4d deposition
  • desensitization strategies
  • donor-specific antibodies (DSA)
  • kidney transplantation
  • late graft failure
  • non-HLA antibodies
  • subclinical AMR detection

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Published Papers (3 papers)

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Research

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17 pages, 1101 KB  
Article
Evaluating the Role of Basiliximab Induction in Simultaneous Liver–Kidney Transplantation: A Multicenter Propensity-Score-Matched Analysis
by Avery Koi, Trine Engebretsen, Alfred S. Lea, Daniel Arango, Heather L. Stevenson and Michael L. Kueht
Antibodies 2025, 14(4), 91; https://doi.org/10.3390/antib14040091 - 28 Oct 2025
Cited by 1 | Viewed by 1764
Abstract
Introduction: Simultaneous liver–kidney (SLK) transplant recipients are considered at lower immunologic risk than kidney-alone recipients, so steroid-only induction is often used. However, some centers continue to include basiliximab induction in their protocols. This study compared graft and infectious outcomes in SLK recipients receiving [...] Read more.
Introduction: Simultaneous liver–kidney (SLK) transplant recipients are considered at lower immunologic risk than kidney-alone recipients, so steroid-only induction is often used. However, some centers continue to include basiliximab induction in their protocols. This study compared graft and infectious outcomes in SLK recipients receiving basiliximab (Bas) induction versus those without basiliximab (No Bas). Methods: Using TriNetX, we conducted a retrospective, propensity-score-matched study of SLK recipients comparing 3-, 6-, and 12-month graft and infectious outcomes. Patients receiving alemtuzumab or anti-thymocyte globulin were excluded; steroid induction was permitted but not required in either cohort. Maintenance immunosuppression included tacrolimus, mycophenolate, and prednisone. Cohorts were matched on 71 variables, including demographics, disease etiology, severity markers, and cPRA. Results: After matching, 292 patients were included per cohort (mean age 56.9 ± 10.1 years; 61% male). Kidney and liver rejection rates were similar. The No Bas cohort had more liver biopsies (25.5% vs. 18.2% at 1 year, p = 0.04). Kidney biopsy, graft failure, re-transplantation, delayed graft function, and mortality were comparable. Liver primary non-function was more frequent in Bas (2.8% vs. 0.4%, p = 0.04). The No Bas cohort had higher CMV at 3 months (13.4% vs. 6.7%, p = 0.008) and higher EBV at all time points (4.0% vs. 0.4% at 1 year, p = 0.004). Conclusions: SLK recipients without basiliximab induction had comparable rejection outcomes but more viral infections, potentially from greater steroid exposure, and more liver biopsies, which may reflect higher clinical suspicion for rejection or incomplete capture of rejection events in EMR data. Full article
(This article belongs to the Special Issue Antibody-Mediated Rejection in Kidney Transplantation)
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Review

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16 pages, 992 KB  
Review
Advancing Antibody Titer Assessment in ABO-Incompatible Transplantation
by Masayuki Tasaki, Kazuhide Saito and Kota Takahashi
Antibodies 2025, 14(3), 78; https://doi.org/10.3390/antib14030078 - 15 Sep 2025
Cited by 1 | Viewed by 3604
Abstract
Background: The accurate evaluation of anti-ABO antibodies is essential for risk stratification in ABO-incompatible (ABOi) transplantation. Historically, hemagglutination-based titration has been the cornerstone of such an assessment; however, different tools are being evaluated in this context. In recent years, several novel methods [...] Read more.
Background: The accurate evaluation of anti-ABO antibodies is essential for risk stratification in ABO-incompatible (ABOi) transplantation. Historically, hemagglutination-based titration has been the cornerstone of such an assessment; however, different tools are being evaluated in this context. In recent years, several novel methods have been reported. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar, focusing on recent studies evaluating anti-ABO antibody measurement techniques in the context of ABOi organ transplantation. Results: In addition to the conventional tube method, techniques such as column agglutination technology, flow cytometry, and enzyme-linked immunosorbent assay are utilized for anti-ABO antibody assessment. However, any particular technique, significant interinstitutional and interoperator variabilities have been reported due to differences in the detailed protocols and the inherently subjective nature of some techniques. Moreover, these assays are based on the antibody binding to ABO antigens expressed on red blood cells, which might not accurately reflect the clinical context of organ transplantation. In recent years, technological advances have enabled the development of novel assays evaluating antibody responses specifically against the ABO antigens expressed on vascular endothelial cells. These include glycan microarrays, which differentiate responses by ABO antigen subtypes, and CD31-based microarrays, wherein recombinant CD31 proteins expressing ABO antigens are immobilized. These approaches are applied to assess clinically relevant anti-ABO antibodies in the context of ABOi organ transplantation. Conclusions: The objective evaluation of antibody titers against ABO antigens on vascular endothelial cells might not only enable a more accurate risk assessment but also facilitate meaningful comparisons between institutions. Full article
(This article belongs to the Special Issue Antibody-Mediated Rejection in Kidney Transplantation)
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13 pages, 653 KB  
Review
Regulatory T Cell in Kidney Transplant: The Future of Cell Therapy?
by Ahmad Matarneh, Meet Patel, Kinna Parikh, Amanda Karasinski, Gurwant Kaur, Vaqar Shah, Nasrollah Ghahramani and Naman Trivedi
Antibodies 2025, 14(2), 49; https://doi.org/10.3390/antib14020049 - 17 Jun 2025
Cited by 6 | Viewed by 5308
Abstract
The long-term use of immunosuppressive drugs following kidney transplantation increases the risk of life-threatening infections, malignancies, and, paradoxically, eventual allograft rejection. Therefore, achieving a balance between over-immunosuppression and under-immunosuppression is critical to optimizing patient outcomes. One promising approach is immune cell-based therapy using [...] Read more.
The long-term use of immunosuppressive drugs following kidney transplantation increases the risk of life-threatening infections, malignancies, and, paradoxically, eventual allograft rejection. Therefore, achieving a balance between over-immunosuppression and under-immunosuppression is critical to optimizing patient outcomes. One promising approach is immune cell-based therapy using suppressor immune cells to modulate the immune response more precisely. Among these, regulatory T cells (Tregs) are the most extensively studied and have shown significant potential in the post-transplant setting. Tregs are broadly categorized into thymus-derived and peripherally derived subsets. Physiologically, they play key roles in maintaining immune tolerance, including in autoimmune diseases and within the tumor microenvironment. Their immunosuppressive functions are mediated through both contact-dependent and contact-independent mechanisms. Studies investigating the use of Tregs following kidney transplantation have shown encouraging results. This review summarizes the biology of Tregs and highlights current evidence supporting their role in transplant immunotherapy. Full article
(This article belongs to the Special Issue Antibody-Mediated Rejection in Kidney Transplantation)
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