Donor-specific antibodies are associated with refractory rejection episodes and poor allograft outcomes in solid organ transplantation. Our understanding of antibody-mediated allograft injury is expanding beyond complement deposition. In fact, unique mechanisms of alloantibodies are advancing our knowledge about transplant vasculopathy and antibody-mediated rejection. These include direct effects on the endothelium, resulting in the recruitment of leukocytes, chemokine and cytokine production, and stimulation of innate and adaptive alloresponses. These effects will be the focus of the following review.
Keywords: alloantibodies; antibody-mediated rejection; complement; endothelium; human leukocyte antigen class I; therapy; transplant vasculopathy.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.