Despite the advances in immunosuppressive therapies and improvements in short-term allograft survival, acute rejection still represents one of the major causes of graft loss. We present a case of early acute T-cell-mediated rejection treated efficaciously with pulse steroids and we review the current literature on the pathogenesis, diagnosis, and treatment of acute T-cell-mediated rejection. Pathogenetic mechanisms involve recruitment, activation, and proliferation of donor-specific T-cells, capable of inducing graft injury through direct and indirect mechanisms. Histologically, Banff classification provides standardized and reproducible definitions and scoring for rejection categories, including T-cell mediated rejection (TCMR) and borderline for TCMR. Although allograft biopsy still represents the gold standard for acute rejection diagnosis, new non-invasive biomarkers are emerging to improve diagnostic timeliness and assist therapeutic choices.
Therapy of TCMR largely depends on histologic severity and may range from the adjustment of maintenance immunosuppressive therapy to the use of thymoglobulin and other aggressive immunosuppressive approaches. Finally, the response to the anti-rejection treatment is normally detected through serum creatinine and surveillance biopsies. However, new biomarkers are emerging to non-invasively monitor this response.
Keywords: Kidney transplantation, Graft rejection, Graft rejection diagnosis, Graft rejection treatment, Graft rejection prognosis