Antibody testing for cardiac antibody-mediated rejection: Which panel correlates best with cardiovascular death?

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

“…27,41 Presence of C3d, a complement split product, is also used to diagnose AMR. 23,38,[42][43][44][45][46] (Figures 1 and 2). Like C4d, C3d persists in tissues longer than C3 and C1q, but because C3d cleavage occurs further downstream in the complement cascade, it indicates progression of complement activation.…”

Biopsy-diagnosed antibody-mediated rejection based on the proposed International Society for Heart and Lung Transplantation working formulation is associated with adverse cardiovascular outcomes after pediatric heart transplant

“…Surveillance for AMR was performed routinely within the first 8 to 12 weeks after HT as previously described. 3,12 Thereafter, immunofluorescence (IF) studies were done if there was a history of AMR, vasculitis by light microscopy, or clinical evidence of hemodynamic compromise. A biopsy positive for AMR was determined by prominent HLA-DR staining and the co-localization of immunoglobulin (IgG or IgM) and complement (C3d, C1q or C4d) in a vascular distribution as highlighted using IF staining of frozen tissue sections.…”

Pathologic evaluation for antibody-mediated rejection: Prognostic vs diagnostic markers?

“…Second, Revelo 2 This is not surprising given that the usefulness of detection of immunoglobulins bound to tissue has been evaluated and found to be non-contributory to the diagnosis of AMR in other studies. 8,9,13,14 The finding of immunoglobulin in the capillaries indicates recognition of an antigen, but does not necessarily indicate injury to the graft.…”

“…11,15 The authors emphasize the need for using HLA-DR to show endothelial activation in AMR. 2 However, they also reported that HLA-DR expression is a common finding that coincides with and persists for up to 2 weeks after an episode of cellular rejection. 16 Thus, such evaluation of HLA-DR may not be specific enough to help pathologists render a diagnosis of AMR vs cellular rejection.…”

“…At this time, the data in the registry do not allow differentiation between cellular rejection and antibody-mediated rejection (AMR). 1 In this issue of the Journal, Revelo et al, 2 from the Utah Transplant Affiliated Hospitals (U.T.A.H.) cardiac transplant program, provide another installment, among the many others by this group over the years, on what they called vascular or microvascular rejection, now widely accepted as AMR.…”