Prevention, Diagnosis and Treatment of Acute Kidney Transplant Rejection

Kidney transplant rejection is complex clinical problem with long-lasting consequences for the patient. The focus of this thesis is optimization of the maintenance immunosuppressive therapy, diagnosis and treatment of kidney transplant rejection. The conclusions of this thesis are:
i) belatacept remains a promising immunosuppressive drug for subgroups of kidney transplant recipients, for instance in patients with post-transplantation diabetes mellitus, but a more tailored strategy in the selection of kidney transplant recipients, treatment regimen and post-conversion monitoring is necessary to expand the use,
ii) novel applications, such as gene expression profiling of kidney transplant biopsies and a proteomic assay in the blood have the ability to improve the diagnosis of acute kidney transplant rejection,
iii) alemtuzumab and rATG are both effective drugs to treat glucocorticoid-resistant, severe or recurrent acute kidney transplant rejections (both aTCMR and ABMR). The advantage of alemtuzumab above rATG is that alemtuzumab is associated with less severe infusionrelated side effects, a shorter hospital stay and lower costs, and
iv) the use of alemtuzumab is associated with secondary auto-immune disorders, such as inflammatory polyneuropathy and acquired hemophilia A, and this risk may be higher compared with the use of rATG