Recent Advances in the Diagnosis and Treatment of Antibody-Mediated Rejection in Pediatric Kidney Transplants

Antibody-mediated rejection (ABMR) accounts for 35.6% of allograft losses in pediatric renal transplant recipients, with an average time of 3 years from diagnosis to failure (North American Pediatric Renal Trials and Collaborative Studies. 2010, Wiebe C, et al. Am J Transplant. 15(11):2921-30, 2015, Kim JJ, et al. Am J Transplant. 14(10):2350-8, 2014). The two main reasons that ABMR is so devastating to a transplanted kidney is that ABMR is challenging to diagnose and to treat. The human leukocyte antigen (HLA) field is growing ever more complex. Banff criteria are also changing and now include molecular diagnosis criteria and C4d-negative ABMR. The optimal therapy for ABMR is not well defined in children or adults. The ultimate goal should be to prevent ABMR, but until we meet that goal, there is still the need to continue to look for the safest and most efficacious therapies. In this chapter, we review the literature on the newest techniques available to help with the diagnosis of ABMR and the available therapeutic options.