Measuring alloreactive B cell responses in transplant recipients.

PURPOSE: Despite advanced immunosuppression, donor-specific antibodies (DSA) remain the leading cause of acute and chronic transplant tissue injury. Comprehensive evaluation of anti-donor humoral immune responses is critical for successful prevention, diagnosis and treatment of antibody-mediated rejection. This review summarizes the evolution of techniques used for this purpose in experimental and clinical transplantation. RECENT
FINDINGS: For decades, measuring DSA serum levels was the only way to assess recipient humoral immunity. Recently, the interest shifted from quantifying circulating DSA to the analyses of various B cell subsets and most importantly, of donor antigen-specific B cells. State-of-the-art approaches have been developed by studies of model antigens, infectious agents and autoimmunity. These methods are now being adopted by the transplantation field.
SUMMARY: The complexity of humoral immunity caused by organ transplantation necessitates complementary approaches assessing both DSA and various B cell subsets to successfully target antibody-mediated rejection.