Clinical management of renal transplant patients with donor-specific alloantibody: the state of the art.

Our understanding of the role of DSA in both early and late renal allograft injury has advanced significantly over the past decade. Novel protocols have been developed that have led to improved outcomes both in overcoming a positive crossmatch and in the treatment of early AMR. Early experience with bortezomib and eculizumab are encouraging and suggest the possibility of validation in controlled clinical trials. While alloantibody remains an extremely difficult clinical problem and it is unclear if overcoming early hurdles will only be followed by another major hurdle of chronic antibody mediated injury. However, it is clear that significant advances have occurred and if future studies can be designed appropriately, then our ability to control alloantibody in sensitized patients will continue to improve.