Abstract

Antibody-mediated rejection represents a significant barrier to favourable long-term outcomes after kidney transplantation and is the most common cause of allograft failure. Therapeutic apheresis techniques associated with other treatments, such as immunosuppressive drugs, are commonly used in the prevention and treatment of antibody-mediated injury in pre- and post-transplant protocols. The rationale is related to the removal of donor-specific antibodies as well as other inflammatory mediators, including cytokines, chemokines, complement degradation molecules, and immunomodulatory effects also which determine an increased susceptibility of cell-mediated and humoral immunity to immunosuppressive agents. In this review article, we discuss current knowledge in the use of therapeutic apheresis in the prevention and management of antibody-mediated rejection, in combination with known and other emerging biological immunosuppressive therapies.

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