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

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C.C. Baan (Carla) , D.A. Hesselink (Dennis) , M.C. Clahsen-van Groningen (Marian)
Erasmus University Rotterdam
Department of Internal Medicine

van der Zwan, M. (2020, October 14). Prevention, Diagnosis and Treatment of Acute Kidney Transplant Rejection. Erasmus University Rotterdam. Retrieved from