The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation

Berry, Gerald J.; Burke, Margaret; Andersen, Claus B; Bruneval, Patrick; Fedrigo, Marny; Fishbein, Michael C.; Goddard, Martin; Hammond, Elizabeth H.; Leone, Ornella; Marboe, Charles C.; Miller, Dylan V.; Neil, Desley; Rassl, Doris M.; Revelo, Mônica P.; Rice, Alexandra; Rodríguez, E. René; Stewart, Susan; Tan, Carmela D.; Winters, Gayle L.; West, Lori J.; Mehra, Mandeep R.; Angelini, Annalisa

doi:10.1016/j.healun.2013.08.011

Cited by 471 publications

(443 citation statements)

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“…The diagnostic criteria for AMR in those solid organ transplants (SOTs) are robust and well established (3,4), with specific subtypes of rejection now being deciphered based on molecular microscopy (5-7) or outcome studies of large populations (8,9). In contrast, diagnosis of AMR in the context lung transplantation (LT) remains a challenging concern that has been highlighted by different groups (10,11).…”

Section: Introductionmentioning

confidence: 99%

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

Roux

Lan

Holifanjaniaina

et al. 2016

American Journal of Transplantation

121

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Section: Introductionmentioning

confidence: 99%

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

Roux

Lan

Holifanjaniaina

et al. 2016

American Journal of Transplantation

121

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“…In 2013, the International Society for Heart & Lung Transplantation (ISHLT, Addison, Texas) published a ''working formulation'' to standardize pathologic diagnosis and nomenclature of ABMR, based on accumulated data in the literature, consensus conferences, and workshops, and reviewed in several recent publications. 13,[67][68][69] The current pathologic diagnostic construct relies on histologic evidence of microvascular injury (see Table 1) as well as immunophenotypic criteria on biopsy and no longer requires organ dysfunction or (unlike kidney) serologic evidence of donorspecific antibodies. 13 However, clinicopathologic correlation remains paramount for patient management, and diagnostic criteria will evolve.…”

Section: Heartmentioning

confidence: 99%

“…13,[67][68][69] The current pathologic diagnostic construct relies on histologic evidence of microvascular injury (see Table 1) as well as immunophenotypic criteria on biopsy and no longer requires organ dysfunction or (unlike kidney) serologic evidence of donorspecific antibodies. 13 However, clinicopathologic correlation remains paramount for patient management, and diagnostic criteria will evolve.…”

Section: Heartmentioning

confidence: 99%

“…13,28,70 As in other allograft organs, antibody and C4 activation at, and C4d deposition on, the endothelium of the microvasculature is the diagnostically significant pattern. In heart, microvasculature includes the network of interstitial capillaries between cardiac myocytes, and any other labeling is considered nonspecific, including the endothelium or elastica of larger arteries, capillaries in Quilty lesions, capillaries in areas of fibrosis, necrotic myocytes, subendocardial connective tissue, and luminal reactivity (serum) in vessels of any size.…”

Section: Heartmentioning

confidence: 99%

“…In general, evaluation of ABMR typically requires correlation of histologic findings (evidence of tissue damage, which often manifests as intracapillary inflammatory cells, termed capillaritis, see Table 1), immunostaining (C4d deposition in capillaries as a hallmark of antibody-mediated damage), and immunologic data (presence of donor-specific antibodies that may remain elusive in the case of non-HLA antibodies). [7][8][9][10][11][12][13][14] Many antibody reagents are available for detection of C4d deposits in transplant biopsies (sampled in Table 2). Some of these reagents are best applied to frozen tissue with immunofluorescence (IF) detection; others are applicable to formalin-fixed, paraffin-embedded tissue, with immunohistochemical (IHC)/immunoperoxidase (IP) detection, or both.…”

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confidence: 99%

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Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

Troxell¹,

Lanciault

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Immunohistochemical analysis of tissue biopsy specimens is a crucial tool in diagnosis of both rejection and infection in patients with solid organ transplants. In the past 15 years, the concept of antibody-mediated rejection has been refined, and diagnostic criteria have been codified in renal, heart, pancreas, and lung allografts (with studies ongoing in liver, small intestine, and composite grafts), all of which include immunoanalysis for the complement split product C4d.Objectives.-To review the general concepts of C4d biology and immunoanalysis, followed by organ-allograftspecific data, and interpretative nuances for kidney, pancreas, and heart, with discussion of early literature for lung and liver biopsies. Additionally, practical applications and limitations of immunostains for infectious organisms (Polyomavirus, Adenoviridae [adenovirus], and the herpes virus family, including Herpes simplex virus, Cytomegalovirus, Human herpes virus 8, and Epstein-Barr virus) are reviewed in the context of transplant recipients.Data Sources.-Our experience and published primary and review literature.Conclusions.-Immunohistochemistry continues to have an important role in transplant pathology, most notably C4d staining in assessment of antibody-mediated rejection and assessment of viral pathogens in tissue. In all facets of transplant pathology, correlation of morphology with special studies and clinical data is critical, as is close communication with the transplant team.

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Socioeconomic Status and Major Adverse Transplant Events in Pediatric Heart Transplant Recipients

Hartje-Dunn,

Gauvreau,

Bastardi

et al. 2024

JAMA Netw Open

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ImportanceLow socioeconomic status (SES) has been associated with higher risk of rejection and graft loss in pediatric heart transplant (HT) recipients. The association of SES with other posttransplant morbidities is unknown.ObjectiveTo assess whether low SES is associated with higher risk of a major adverse transplant event (MATE) among pediatric HT recipients.Design, Setting, and ParticipantsRetrospective single-center cohort study at a children’s hospital in Boston with consecutive primary HT recipients from 2006 to 2019 and follow-up through 2022. Data were analyzed from June 2023 to March 2024.ExposureVery low or low, moderate, and high or very high Childhood Opportunity Index (COI) for neighborhood (census tract) of patient residence.Main Outcomes and MeasuresPrimary outcome was 3-year MATE-6 score assessed in 6-month survivors as cumulative burden of acute cellular rejection, antibody-mediated rejection, coronary vasculopathy, lymphoproliferative disease, kidney dysfunction, and infection, each as an ordinal score from 0 to 4 (24 for death or retransplant). Secondary outcomes were freedom from rejection during first 6 months, freedom from death or retransplant, MATE-3 score for events 1 to 3 (under immune suppression) and events 4 to 6 (chronic immune suppression effects), and each MATE component.ResultsOf 153 children analyzed, the median (IQR) age at HT was 7.2 (1.5-14.8) years, 99 (65%) were male, 16 (10%) were Black, 17 (11%) were Hispanic, and 106 (69%) were White. Fifty patients (33%) lived in very low or low, 17 (11%) in moderate, and 86 (56%) in high or very high COI neighborhoods. There was no significant group difference in mean (SD) 3-year MATE-6 score (very low or low COI, 3.4 [6.5]; moderate COI, 2.4 [6.3]; and high or very high COI, 4.0 [6.9]). Furthermore, there was no group difference in mean (SD) MATE-3 scores for underimmune suppression (very low or low COI, 1.9 [3.5]; moderate COI, 1.2 [3.2]; and high or very high COI, 2.2 [3.6]), chronic immune suppression effects (very low or low COI, 1.6 [3.3]; moderate COI, 1.1 [3.2]; and high or very high COI, 1.8 [3.6]), individual MATE components, rejection during the first 6 months, or death or retransplant.Conclusions and relevanceIn this cohort study of pediatric HT recipients, there was no difference in posttransplant outcomes among recipients stratified by SES, a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.

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The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation

Cited by 471 publications

References 31 publications

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

Socioeconomic Status and Major Adverse Transplant Events in Pediatric Heart Transplant Recipients

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