Humoral immunity in kidney transplantation

There are more than 76,000 end-stage renal disease patients waiting for one of the 17,000 kidneys transplanted each year, making a host rejection an unacceptable waste.

Kidney transplantation is the preferred treatment for patients with end-stage renal disease. As the demand for organs exceeds the supply, blood group (ABO)-incompatible kidney transplantations have gained much importance and humoral immunity is of crucial importance in ABO-incompatible transplants. Humoral immunity is the immune response triggered by antibodies expressed in bodily fluids, which, in turn, plays a vital part in a transplant patient's immune response to the donour organ. Although initial outcomes were poor, meanwhile more than 200 ABO-incompatible kidney transplantations have been performed successfully in Europe thanks to the improvements in managing humoral immunity. These treatment protocols rely on strategies to remove ABO antibodies before and after transplantation, to impair the B cell compartment and to use immunomodulators such as intravenous immunoglobulin.

Aimed especially at the clinician, this book presents recent insights into the characterization and pathogenetic role of humoral immunity in chronic allograft injury and investigates the perspectives for novel immunosuppressive therapies to control antibody production after transplantation. It is an indispensable update for all those involved in the care of kidney transplant patients.