351: Refining the identification of discriminatory genes for rejection in lung transplantation: The LARGO Study

Keshavjee, S.; Berry, Gerald J.; Marboe, C.; Wilt, Jessie S.; Trulock, Elbert P.; Corris, PA; Doyle, Ramona L.; McCurry, K.R.; Arcasoy, Selim M.; Davis, R. D.; Golden, Jeff; Strueber, M.; Sweet, Stuart C.; Jaksch, Péter; Mehta, Atul C.; Mulligan, M.S.; Pajaro, O. E.; Sun, Ji; Klingler, Tod M.; Rosenberg, Steven; Dedrick, R.D.; Wolters, H.; Fang, Kenneth C.; Zamora, Martin R.

doi:10.1016/j.healun.2006.11.372

Cited by 4 publications

(2 citation statements)

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“…A similar study is now underway in lung transplantation, known as the lung allograft rejection gene expression observational (LARGO) study. Preliminary data from almost 900 patients, similarly to the CARGO results, show differential gene expression in the lymphocyte priming and neutrophil homeostasis pathways for A0 versus > A2 acute lung rejection (30). Additional data and its further validation may bring about a peripheral blood test for an acute rejection gene expression signature, which could reduce the frequency of invasive diagnostic procedures in the future.…”

Section: Diagnosis Of Acute Lung Allograft Rejectionmentioning

confidence: 66%

Acute Rejection and Humoral Sensitization in Lung Transplant Recipients

Martinu¹,

Chen²,

Palmer³

2009

Proceedings of the American Thoracic Society

153

108

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Despite the recent introduction of many improved immunosuppressive agents for use in transplantation, acute rejection affects up to 55% of lung transplant recipients within the first year after transplant. Acute lung allograft rejection is defined as perivascular or peribronchiolar mononuclear inflammation. Although histopathologic signs of rejection often resolve with treatment, the frequency and severity of acute rejections represent the most important risk factor for the subsequent development of bronchiolitis obliterans syndrome (BOS), a condition of progressive airflow obstruction that limits survival to only 50% at 5 years after lung transplantation. Recent evidence demonstrates that peribronchiolar mononuclear inflammation (also known as lymphocytic bronchiolitis) or even a single episode of minimal perivascular inflammation significantly increase the risk for BOS. We comprehensively review the clinical presentation, diagnosis, histopathologic features, and mechanisms of acute cellular lung rejection. In addition, we consider emerging evidence that humoral rejection occurs in lung transplantation, characterized by local complement activation or the presence of antibody to donor human leukocyte antigens (HLA). We discuss in detail methods for HLA antibody detection as well as the clinical relevance, the mechanisms, and the pathologic hallmarks of humoral injury. Treatment options for cellular rejection include high-dose methylprednisolone, antithymocyte globulin, or alemtuzumab. Treatment options for humoral rejection include intravenous immunoglobulin, plasmapheresis, or rituximab. A greater mechanistic understanding of cellular and humoral forms of rejection and their role in the pathogenesis of BOS is critical in developing therapies that extend long-term survival after lung transplantation.

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Section: Diagnosis Of Acute Lung Allograft Rejectionmentioning

confidence: 66%

Acute Rejection and Humoral Sensitization in Lung Transplant Recipients

Martinu¹,

Chen²,

Palmer³

2009

Proceedings of the American Thoracic Society

153

108

View full text Add to dashboard Cite

show abstract

“…A similar study is now underway in lung transplantation, known as the lung allograft rejection gene expression observational (LARGO) study. Preliminary data from almost 900 patients show differential gene expression in the lymphocyte priming and neutrophil homeostasis pathways for A0 versus ≥A2 acute lung rejection [32]. Such testing may hold promise for a noninvasive technique to monitor the status of the transplanted organs.…”

Section: Transbronchial Biopsymentioning

confidence: 99%

The Pathology of Lung Allograft Rejection: A Concise Review

Roden¹,

Tazelaar²

2012

Tur Toraks Der

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Lung transplantations in humans have been performed for almost 50 years. However, allograft rejection, non-rejection diseases such as harvest/reperfusion injury, infection, drug toxicity, post-transplant lymphoproliferative diseases, and recurrent disease are still significant complications. Although the clinical impression might suggest the possibility of any of these conditions, tissue diagnosis is usually necessary to establish a definitive diagnosis. This article mainly focuses on reviewing the morphological features of lung allograft rejection and its grading according to the revised 2007 ISHLT consensus classification of allograft rejection. Acute and chronic alloreactive injuries affect both the vasculature and the airways. Currently, the guidelines of the 2007 ISHLT consensus conference are used for the histolopathologic assessment of rejection. Although antibody mediated rejection is recognized in heart and kidney transplants, at present, there is no consensus about its diagnosis in transplanted lungs. Mimickers of rejection and posttransplant diseases will also be discussed. The collaboration between the transplant clinician and pathologist cannot be overemphasized to establish an optimal treatment for the individual patient following lung transplantation. (

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Lung

Roden

Tazelaar

2009

Pathology of Solid Organ Transplantation

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351: Refining the identification of discriminatory genes for rejection in lung transplantation: The LARGO Study

Cited by 4 publications

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Acute Rejection and Humoral Sensitization in Lung Transplant Recipients

Acute Rejection and Humoral Sensitization in Lung Transplant Recipients

The Pathology of Lung Allograft Rejection: A Concise Review

Lung

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