Antibody-Mediated Rejection of Solid-Organ Allografts

End-stage organ diseases are responsible for millions of deaths worldwide each year. Organ transplantation has become the treatment of choice, but despite the 120,000 new organ transplantations performed each year, only 1 million persons worldwide have functioning solid-organ transplants1 because of the lack of improvement in long-term allograft survival over the past few decades and the limited organ supply.

HLA incompatibility between donors and recipients who are not genetically identical has been identified as the main barrier to successful transplantation, mostly because of antibody-mediated rejection, a form of allograft rejection triggered by the production of antibodies directed mainly toward donor (nonself) HLA molecules. ​

This review focuses on current standards for the management of antibody-mediated rejection in transplant recipients and identifies future directions for improving diagnostics and moving toward tailored therapeutics. Such advances require the development of pathogenesis-based approaches that combine precise characterization of the biologic properties of antibodies, noninvasive biomarkers, and allograft gene-expression profiling, which will set the stage for bringing antibody-mediated rejection into the era of precision medicine.

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