Recommended Treatment for Antibody-mediated Rejection after Kidney Transplantation: The 2019 Expert Consensus from the Transplantion Society Working Group

Carrie A. Schinstock, Roslyn B. Mannon, Klemens Budde, Anita S. Chong, Mark Haas, Stuart Knechtle, Carmen Lefaucheur, Robert A. Montgomery, Peter Nickerson, Stefan G. Tullius, Curie Ahn, Medhat Askar, Marta Crespo, Steven J. Chadban, Sandy Feng, Stanley C. Jordan, Kwan Man, Michael Mengel, Randall E. Morris, Inish O'dohertyBinnaz H. Ozdemir, Daniel Seron, Anat R. Tambur, Kazunari Tanabe, Jean Luc Taupin, Philip J. O'connell

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

With the development of modern solid-phase assays to detect anti-HLA antibodies and a more precise histological classification, the diagnosis of antibody-mediated rejection (AMR) has become more common and is a major cause of kidney graft loss. Currently, there are no approved therapies and treatment guidelines are based on low-level evidence. The number of prospective randomized trials for the treatment of AMR is small, and the lack of an accepted common standard for care has been an impediment to the development of new therapies. To help alleviate this, The Transplantation Society convened a meeting of international experts to develop a consensus as to what is appropriate treatment for active and chronic active AMR. The aim was to reach a consensus for standard of care treatment against which new therapies could be evaluated. At the meeting, the underlying biology of AMR, the criteria for diagnosis, the clinical phenotypes, and outcomes were discussed. The evidence for different treatments was reviewed, and a consensus for what is acceptable standard of care for the treatment of active and chronic active AMR was presented. While it was agreed that the aims of treatment are to preserve renal function, reduce histological injury, and reduce the titer of donor-specific antibody, there was no conclusive evidence to support any specific therapy. As a result, the treatment recommendations are largely based on expert opinion. It is acknowledged that properly conducted and powered clinical trials of biologically plausible agents are urgently needed to improve patient outcomes.

Original languageEnglish (US)
Pages (from-to)911-922
Number of pages12
JournalTransplantation
DOIs
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Transplantation

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    Schinstock, C. A., Mannon, R. B., Budde, K., Chong, A. S., Haas, M., Knechtle, S., Lefaucheur, C., Montgomery, R. A., Nickerson, P., Tullius, S. G., Ahn, C., Askar, M., Crespo, M., Chadban, S. J., Feng, S., Jordan, S. C., Man, K., Mengel, M., Morris, R. E., ... O'connell, P. J. (Accepted/In press). Recommended Treatment for Antibody-mediated Rejection after Kidney Transplantation: The 2019 Expert Consensus from the Transplantion Society Working Group. Transplantation, 911-922. https://doi.org/10.1097/TP.0000000000003095