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

Rodríguez, E. René; Tan, Carmela D.

doi:10.1016/j.healun.2010.09.014

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…The role of antibody-mediated rejection in acute and chronic cardiac allograft dysfunction is now firmly established [7–9]. However, the topic has been steeped in controversy in heart transplantation stemming from an inability for many years to come to a consensus on the clinical and pathologic diagnosis and on the appropriate treatment [10–12]. In part, the difficulty in defining this process arises from the still emerging understanding of the cellular and molecular mechanisms involved.…”

Section: Review and Discussionmentioning

confidence: 99%

Antibody-Mediated Rejection in Heart Transplantation: Case Presentation with a Review of Current International Guidelines

Pajaro

Jaroszewski

Scott

et al. 2011

Journal of Transplantation

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Antibody-mediated rejection (AMR) (humoral rejection) of cardiac allografts remains difficult to diagnose and treat. Interest in AMR of cardiac allografts has increased over the last decade as it has become apparent that untreated humoral rejection threatens graft and patient survival. An international and multidisciplinary consensus group has formulated guidelines for the diagnosis and treatment of AMR and established that identification of circulating or donor-specific antibodies is not required and that asymptomatic AMR, that is, biopsy-proven AMR without cardiac dysfunction is a real entity with worsened prognosis. Strict criteria for the diagnosis of cardiac AMR have not been firmly established, although the diagnosis relies heavily on tissue pathological findings. Therapy remains largely empirical. We review an unfortunate experience with one of our patients and summarize recommended criteria for the diagnosis of AMR and potential treatment schemes with a focus on current limitations and the need for future research and innovation.

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Section: Review and Discussionmentioning

confidence: 99%

Antibody-Mediated Rejection in Heart Transplantation: Case Presentation with a Review of Current International Guidelines

Pajaro

Jaroszewski

Scott

et al. 2011

Journal of Transplantation

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“…Against the background of the emerging literature in this area, surveys and multicenter studies done under the leadership of the International Society of Heart and Lung Transplantation (ISHLT), the Association of the European Cardiovascular Pathologists, and the Banff Heart Group, these fundamental diagnostic criteria were extensively discussed at a recent ISHLT Consensus Conference [74]. It became obvious that a significant variance still exists in how different centers render the diagnosis of ABMR, interpret DSA findings, and stain and interpret C4d and other immune-pathological markers [75]. The current proposal by the ISHLT suggests that the combination of histopathologic and immunopathologic findings will be reported as ''pathologic ABMR'' (pABMR) ('p' for pathology).…”

Section: Abmr In Heart Transplantsmentioning

confidence: 99%

Phenotypes of antibody-mediated rejection in organ transplants

Mengel

Husain

Hidalgo

et al. 2012

Transplant International

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Summary Antibody‐mediated hyperacute rejection was the first rejection phenotype observed in human organ transplants. This devastating phenotype was eliminated by reliable crossmatch technologies. Since then, the focus was on T‐cell‐mediated rejection and de novo donor‐specific antibodies were considered an epiphenomenon of cognate T‐cell activation. The immune theory was that controlling the T‐cell response would entail elimination of antibody‐mediated rejection (ABMR). With modern immunosuppressive drugs, T‐cell‐mediated rejection is essentially treatable. However, this did not prevent ABMR from emerging as a significant phenotype in all types of organ transplants. It became obvious that both rejection types require distinct treatment and thus reliable diagnosis. This is the current challenge. ABMR, depending on stage, grade, time course, organ type or prior treatment, can present with a wide spectrum of phenotypes. This review summarizes the current diagnostic consensus for ABMR, describes unmet needs and challenges in diagnostics, and proposes new approaches for consideration.

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“…Moreover, it seems possible to treat AMR more and more effectively with the use of modern drugs aimed directly at antibody production [ 8 – 10 ]. Despite these advances, there are still some serious doubts about the role of the complement fragments’ deposition in EMBs [ 11 ], and a proper definition of AMR [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Coincidence of cellular and antibody mediated rejection in heart transplant recipients – preliminary report

Zakliczyński

Nożyński

Konecka-Mrowka

et al. 2014

kitp

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Antibody mediated rejection (AMR) can significantly influence the results of orthotopic heart transplantation (OHT). However, AMR and cellular rejection (CR) coexistence is poorly described. Therefore we performed a prospective pilot study to assess AMR/CR concomitance in endomyocardial biopsies (EMBs) obtained electively in 27 OHT recipients (21 M/6 F, 45.4 ± 14.4 y/o). Biopsy samples were paraffin embedded and processed typically with hematoxylin/eosin staining to assess CR, and, if a sufficient amount of material remained, treated with immunohistochemical methods to localize particles C3d and C4d as markers of antibody dependent complement activation. With this approach 80 EMBs, including 41 (51%) harvested within the first month after OHT, were qualified for the study. Among them 14 (18%) were C3d+, 37 (46%) were C4d+, and 12 (15%) were both C3d and C4d positive. At least one C3d+, C4d+, and C3d/C4d+ EMB was found in 10 (37%), 17 (63%), and 8 (30%) patients, respectively. Among 37 CR0 EMBs C3d was observed in 4 (11%), C4d in 17 (46%), and both C3d/C4d in 3 (8%) cases. Among 28 CR1 EMBs C3d was observed in 3 (11%), C4d in 11 (39%), and C3d/C4d in 3 (11%) cases. Among 15 CR2 EMBs C3d was observed in 7 (47%), C4d in 9 (60%), and C3d/C4d in 6 (40%) cases. Differences in C3d and C3d/C4d occurrence between grouped CR0-1 EMBs and CR2 EMBs (7/65 – 11% vs. 7/15 – 47%; 6/65 – 9% vs. 6/15 – 40%) were significant (p = 0.0035 and p = 0.0091, respectively, χ2 test). In conclusion, apparently frequent CR and AMR coexistence demonstrated in this preliminary study warrants further investigation in this field.

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

Cited by 6 publications

References 23 publications

Antibody-Mediated Rejection in Heart Transplantation: Case Presentation with a Review of Current International Guidelines

Antibody-Mediated Rejection in Heart Transplantation: Case Presentation with a Review of Current International Guidelines

Phenotypes of antibody-mediated rejection in organ transplants

Coincidence of cellular and antibody mediated rejection in heart transplant recipients – preliminary report

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