Antibody-Mediated Rejection: Mechanisms, Pathology, and Therapeutics

The goal of this paper is to review the latest advances in antibody-mediated rejection with regards to lung transplantation. We review definitions, mechanisms, pathology, and the most recent therapeutics that have been trialed for treating AMR. We hope to answer questions regarding diagnostic ambiguity that previously surrounded AMR and hope to shed light to the latest treatments which have shown promise in recent clinical trials. We review the benefits of single bead Luminex assays, and how the implementation of these assays has improved detection for donor specific antibodies, a key component in the diagnosis of AMR. We also explore other serum markers that may be beneficial in the diagnosis of AMR such as p-S5RP, and cell- free DNA. There are new treatment options to consider such as the IL6 inhibitors Tocilizumab and clazakizumab, as well as tyrosine kinase inhibitors such as felzartamab or inflimidase, all of which have shown some promise for treating AMR.