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Welcome to the second part of this talk on clinical transplantation.
In the first part, I covered aspects that affect outcomes in clinical transplantation.
In the second part of the talk I'm going to be covering the approaches that are being taken to
minimise the side-effects of non-specific immunosuppression,
including the approaches that are being developed towards tolerance in clinical organ transplantation.
How do we diagnose antibody-mediated rejection in the kidney?
There are a number of studies now trying to refine the information that is
used by both the pathologists and the clinical teams, to diagnose antibody-mediated rejection.
This is constantly evolving through the Banff organisation, through both pathology and
as other markers including the presence of antibodies,
things are becoming more detectable before severe damage to the graft has been done.
To detect antibody-mediated damage to a transplanted kidney,
there is clinical evidence, because the graft starts to function poorly, and sometimes
goes into complete dysfunction; this can be monitored very well using biochemical parameters.
The presence of the antibodies in the circulating plasma of the patient can be detected now,
and at most centres patients will have blood taken on a regular basis,
to look for the presence of these antibodies which can potentially damage the graft.
If the graft is showing some degree of dysfunction, for kidneys the graft can be biopsied,
and that biopsy analysed by a skilled pathologist looking for signs of the rejection process.