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Published ahead of print on March 8, 2006
Clin J Am Soc Nephrol 1: 415-420, 2006
© 2006 American Society of Nephrology
doi: 10.2215/CJN.01881105
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Moving Points in Nephrology

Antibody-Mediated Rejection in Renal Allografts: Lessons from Pathology

Lorraine C. Racusen, and Mark Haas

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Address correspondence to: Dr. Lorraine C. Racusen, Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Pathology 712, Baltimore, MD 21287. Phone: 410-955-2386; Fax: 410-614-7110; E-mail: lracusen{at}jhmi.edu

The past 15 years have seen major advances in the understanding of the effects of anti-donor antibodies on renal allografts at various stages after transplantation. These advances have been due in large part to pathologic examination of both early and late renal allograft biopsies, including both routine histologic evaluation and immunohistology to detect complement split products. As pathologists have become increasingly adept at diagnosing antibody-mediated rejection (AMR) on allograft biopsies, substantial progress has been made in the treatment of AMR and in successful renal transplantation in recipients with pre-existing antibodies against donor blood group (ABO) and/or major histocompatibility (HLA) antigens. This article reviews the pathologic features of hyperacute, acute, and chronic AMR, including some newer findings impacting diagnosis and outcomes, and differences in the implications of similar pathologic findings in ABO- versus HLA-incompatible renal allografts.






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