Abstract
Kidney transplantation is the best therapeutic choice for children with end stage kidney disease. Antibody mediated rejection (AMR) has been recognized as the leading immunological cause of decline of graft function and graft loss in the long run.
AMR is caused by antibodies specific to mismatched donor antigens, i.e. donor specific antibodies (DSA). According to the Banff classification of renal allograft pathology there are three criteria that need to be met for the diagnosis of AMR - detection of DSA in patient's serum, morphologic features of graft lesion and proof of endothelium-antibody interaction, including the presence of C4d deposits in the peritubular capillaries in graft biopsy.
The treatment of AMR remains challenging and requires combination of different modalities. The most commonly used protocols include series of plasmapheresis, intravenous immunoglobulins and rituximab application.