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Current Therapies in Kidney Transplant Rejection
Despite significant advancements in immunosuppressive therapies, kidney transplant rejection continues to pose a substantial challenge, impacting the long-term survival of grafts. This article provides an overview of the diagnosis, current therapies, and management strategies for acute T-cell-mediat...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419508/ https://www.ncbi.nlm.nih.gov/pubmed/37568328 http://dx.doi.org/10.3390/jcm12154927 |
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author | Alasfar, Sami Kodali, Lavanya Schinstock, Carrie A. |
author_facet | Alasfar, Sami Kodali, Lavanya Schinstock, Carrie A. |
author_sort | Alasfar, Sami |
collection | PubMed |
description | Despite significant advancements in immunosuppressive therapies, kidney transplant rejection continues to pose a substantial challenge, impacting the long-term survival of grafts. This article provides an overview of the diagnosis, current therapies, and management strategies for acute T-cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR). TCMR is diagnosed through histological examination of kidney biopsy samples, which reveal the infiltration of mononuclear cells into the allograft tissue. Corticosteroids serve as the primary treatment for TCMR, while severe or steroid-resistant cases may require T-cell-depleting agents, like Thymoglobulin. ABMR occurs due to the binding of antibodies to graft endothelial cells. The most common treatment for ABMR is plasmapheresis, although its efficacy is still a subject of debate. Other current therapies, such as intravenous immunoglobulins, anti-CD20 antibodies, complement inhibitors, and proteasome inhibitors, are also utilized to varying degrees, but their efficacy remains questionable. Management decisions for ABMR depend on the timing of the rejection episode and the presence of chronic changes. In managing both TCMR and ABMR, it is crucial to optimize immunosuppression and address adherence. However, further research is needed to explore newer therapeutics and evaluate their efficacy. |
format | Online Article Text |
id | pubmed-10419508 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104195082023-08-12 Current Therapies in Kidney Transplant Rejection Alasfar, Sami Kodali, Lavanya Schinstock, Carrie A. J Clin Med Review Despite significant advancements in immunosuppressive therapies, kidney transplant rejection continues to pose a substantial challenge, impacting the long-term survival of grafts. This article provides an overview of the diagnosis, current therapies, and management strategies for acute T-cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR). TCMR is diagnosed through histological examination of kidney biopsy samples, which reveal the infiltration of mononuclear cells into the allograft tissue. Corticosteroids serve as the primary treatment for TCMR, while severe or steroid-resistant cases may require T-cell-depleting agents, like Thymoglobulin. ABMR occurs due to the binding of antibodies to graft endothelial cells. The most common treatment for ABMR is plasmapheresis, although its efficacy is still a subject of debate. Other current therapies, such as intravenous immunoglobulins, anti-CD20 antibodies, complement inhibitors, and proteasome inhibitors, are also utilized to varying degrees, but their efficacy remains questionable. Management decisions for ABMR depend on the timing of the rejection episode and the presence of chronic changes. In managing both TCMR and ABMR, it is crucial to optimize immunosuppression and address adherence. However, further research is needed to explore newer therapeutics and evaluate their efficacy. MDPI 2023-07-27 /pmc/articles/PMC10419508/ /pubmed/37568328 http://dx.doi.org/10.3390/jcm12154927 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Alasfar, Sami Kodali, Lavanya Schinstock, Carrie A. Current Therapies in Kidney Transplant Rejection |
title | Current Therapies in Kidney Transplant Rejection |
title_full | Current Therapies in Kidney Transplant Rejection |
title_fullStr | Current Therapies in Kidney Transplant Rejection |
title_full_unstemmed | Current Therapies in Kidney Transplant Rejection |
title_short | Current Therapies in Kidney Transplant Rejection |
title_sort | current therapies in kidney transplant rejection |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419508/ https://www.ncbi.nlm.nih.gov/pubmed/37568328 http://dx.doi.org/10.3390/jcm12154927 |
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