Clinical Trials for Developing Treatment and Early Diagnostic Methods for Chronic Active Antibody-Mediated Rejection in Kidney Transplantation: A Review.

BACKGROUND

Development of immunosuppressants has reduced the incidence of acute T-cell-mediated rejection (TCMR) and significantly improved the short-term outcome of kidney transplantation. However, in the long term, many cases of transplanted kidney failure are due to chronic active antibody-mediated rejection (CAAMR) caused by donor-specific antibodies. Overcoming this is essential for improving long-term outcomes. The mechanism of CAAMR remains largely unknown and no effective treatment is currently available.

SUMMARY: Various therapeutic approaches have been attempted for cases that have progressed to CAAMR. However, an effective treatment method has yet to be established. Therefore, efforts are underway to develop diagnostic methods for identifying patients at risk of developing CAAMR either before its occurrence or as early as possible. Recent reports have identified potential biomarkers in the urine and blood for the early diagnosis of CAAMR. In addition, the molecular analyses of kidney allograft biopsy tissues are being explored for early diagnostic methods. This review summarizes the current treatments for CAAMR and the trials aimed at developing early-stage diagnostic methods for detecting CAAMR.

KEY MESSAGES: Various new diagnostic methods have successively attempted to replace histological examination in the diagnosis of kidney transplant rejection; most have focused on TCMR or acute antibody-mediated rejection. The development of early diagnostic methods for CAAMR is still in its infancy and future advancements are anticipated.