Model of Chronic Allograft Injury in Alloantibody Positive Renal Transplant Patients

Human Leukocyte Antigens (HLA) (donor-specific anti-HLA antibodies, DSA). Circulating DSA detected after implantation of the donor transplanted organ [de novo immunoglobulin G (IgG) DSA(dnDSA)] are now thought to be the major cause of allograft loss [14,15]. In the last 15 years, the body of knowledge on DSA has grown dramatically [14-34]. In the beginning, the research focused on the association between DSA and allograft loss [3336]. With more recent longitudinal studies, there is an increase understanding of the temporal relationship between DSA, DSA changes, and allograft loss [20,37-40]. In addition to the research on DSA, pathology research over the last decade, through clinical and protocol biopsies, has improved the understanding of antibody-mediated injury and chronic rejection pathology [22,38,41-46]. This review discusses about the developments in these areas and how together they provide the framework for developing a model of chronic allograft injury in alloantibody positive renal transplant patients.