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World J Transplant. Sep 24, 2016; 6(3): 564-572
Published online Sep 24, 2016. doi: 10.5500/wjt.v6.i3.564
Updates on antibody-mediated rejection in intestinal transplantation
Guo-Sheng Wu
Guo-Sheng Wu, Division of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi’an 710032, Shannxi Province, China
Author contributions: Wu GS solely contributed to this paper.
Supported by The grant from the National Natural Science Foundation of China, No. 81570588.
Conflict-of-interest statement: The author declares no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guo-Sheng Wu, MD, PhD, Division of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, #127 Changle West Rd, Xi’an 710032, Shannxi Province, China. guosheng_w@yahoo.com
Telephone: +86-29-84771508 Fax: +86-29-82539041
Received: April 29, 2016
Peer-review started: May 3, 2016
First decision: June 17, 2016
Revised: July 30, 2016
Accepted: August 17, 2016
Article in press: August 18, 2016
Published online: September 24, 2016
Processing time: 146 Days and 23.3 Hours
Abstract

Antibody-mediated rejection (ABMR) has increasingly emerged as an important cause of allograft loss after intestinal transplantation (ITx). Compelling evidence indicates that donor-specific antibodies can mediate and promote acute and chronic rejection after ITx. However, diagnostic criteria for ABMR after ITx have not been established yet and the mechanisms of antibody-mediated graft injury are not well-known. Effective approaches to prevent and treat ABMR are required to improve long-term outcomes of intestine recipients. Clearly, ABMR after ITx has become an important area for research and clinical investigation.

Keywords: Intestinal transplantation; Antibody-mediated rejection; Hyperacute rejection; Chronic rejection; Donor-specific antibodies; C4d deposition; Outcomes

Core tip: Antibody-mediated rejection (ABMR) has increasingly surfaced as an important cause of allograft loss after intestinal transplantation. The presence of donor-specific antibodies (DSAs) should alert the clinician of the increased risk of ABMR. The avoidance of a known donor-specific antibody target at the time of transplant remains a primary preventive strategy. The development of newly-formed DSAs usually portends a poor prognosis with an increased risk of refractory acute rejection, chronic rejection, and allograft loss. The better understanding of mechanisms of antibody-mediated graft injury, establishment of the diagnostic criteria, and optimal management of these antibodies may improve clinical outcomes of intestine transplants.