Prospects and limitations of post-transplantation alloantibody detection in renal transplantation

Antibody-mediated immunity is generally accepted to be a major cause of kidney allograft injury and loss. Post-transplantation monitoring for circulating alloantibodies was proposed to represent a useful noninvasive diagnostic approach to assess individual immunologic risks and to guide the implementation of specific therapeutic measures. This was supported by the recent establishment of highly sensitive and specific solid phase immunoassays for detailed characterisation of reactivity patterns. Nevertheless, imperfect associations of serologic results with biopsy-based criteria of antibody-mediated rejection, as well as the disputed long-term significance of circulating alloantibody detected in recipients with normal graft function, necessitate a careful interpretation of monitoring results.