B-Cell Targets to Treat Antibody-Mediated Rejection in Transplantation

Manuel Muro

doi:10.23937/2572-4045.1510023

Abstract

Antibody-mediated rejection (AMR) in allograft transplantation can be defined with a rapid increase in the levels of specific serological parameters after organ transplantation, presence of donor specific antibodies (DSAs) against human leukocyte antigen (HLA) molecules, blood group (ABO) antigens and/or endothelial cell antigens (e.g. MICA, ECA, Vimentin, or ETAR) and also particular histological parameters [1,2]. If the AMR persists or progresses, the treatment to eliminate the humoral component of acute rejection include three sequential steps: (a) steroid pulses, antibody removal (plasma exchange or immuno-adsorption) and high doses of intravenous immunoglobulin-IVIG, (b) Rituximab (anti-CD20) or Bortezomib (anti-proteasome), and finally (c) Eculizumab (anti-C5) and rescue splenectomy.

Highlights

Manuel Muro1*, Santiago Llorente2, Jose A Galian1, Francisco Boix1, Jorge Eguia1, Gema Gonzalez-Martinez1, Maria R Moya-Quiles1 and Alfredo Minguela1
Antibody-mediated rejection (AMR) in allograft transplantation can be defined with a rapid increase in the levels of specific serological parameters after organ transplantation, presence of donor specific antibodies (DSAs) against human leukocyte antigen (HLA) molecules, blood group (ABO) antigens and/or endothelial cell antigens (e.g. MICA, ECA, Vimentin, or ETAR) and particular histological parameters [1,2]
If the AMR persists or progresses, the treatment to eliminate the humoral component of acute rejection include three sequential steps: (a) steroid pulses, antibody removal and high doses of intravenous immunoglobulin-IVIG, (b) Rituximab or Bortezomib, and (c) Eculizumab and rescue splenectomy

Summary

Introduction

Manuel Muro1*, Santiago Llorente2, Jose A Galian1, Francisco Boix1, Jorge Eguia1, Gema Gonzalez-Martinez1, Maria R Moya-Quiles1 and Alfredo Minguela1. B-Cell Targets to Treat Antibody-Mediated Rejection in Transplantation The true role of DSA response to solid allograft and the role of the ontogeny of B cells are not fully understood in all types of transplant, especially in liver transplantation [3,4,5] but it is known the eventual potential of B cell managing to prevent and treat an antibody mediated rejection.

Results

Conclusion