The ISHLT working formulation for pathologic diagnosis of antibody-mediated rejection in heart transplantation: Evolution and current status (2005–2011)

Berry, Gerald J.; Angelini, Annalisa; Burke, Margaret; Bruneval, Patrick; Fishbein, Michael C.; Hammond, Elizabeth H.; Miller, Dylan V.; Neil, Desley; Revelo, Mônica P.; Rodríguez, E. René; Stewart, Susan; Tan, Carmela D.; Winters, Gayle L.; Kobashigawa, Jon A.; Mehra, Mandeep R.

doi:10.1016/j.healun.2011.02.015

Cited by 200 publications

(159 citation statements)

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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%

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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Section: Heartmentioning

confidence: 99%

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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“…The HLAs tested cover a very wide spectrum of known HLAs, however not all HLAs are tested. Limitations of this test included its lack of sensitivity and specificity (Berry et al, 2011). Unfortunately, the differences in clinical impact of circulating donor specific antibodies (DSAs), anti-HLA antibodies, or non-HLA antibodies, comparatively, have not been fully elucidated.…”

Section: Immunologic Screeningmentioning

confidence: 99%

“…Most recently in 2011, the International Society for Heart and Lung Transplantation (ISHLT) published their outcomes from a consensus conference regarding AMR in heart transplantation (Kobashigawa et al, 2011) as well as a breakout group working formulation regarding pathologic diagnosis of AMR in heart transplantation (Berry et al, 2011). While these two documents provide some direction for practitioners and transplant providers, many questions remained unanswered and the rapid evolution of novel therapies and strategies for treatment will likely change the field of AMR in the heart transplant population dramatically.…”

Section: Introductionmentioning

confidence: 99%

Antibody Mediated Rejection of the Cardiac Allograft

Ensor¹,

Doligalski²

2012

Cardiac Transplantation

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“…In April 2010, a publication from the ISHLT Consensus Conference assessed the status of AMR in heart transplantation and a pathologic grading scale was devised [4].…”

Section: Introductionmentioning

confidence: 99%

“…To minimize the risk of a false negative, multiple specimens (usually [3][4][5] are obtained from 3 different sites. Though rare, false negatives do exist either through sampling error, artifact, Quilty lesions, or pathology misread.…”

Section: Introductionmentioning

confidence: 99%

683 The Natural History of Biopsy Negative Rejection after Heart Transplantation

Patel¹,

Kittleson²,

Rafiei³

et al. 2012

The Journal of Heart and Lung Transplantation

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.Purpose. The most recent International Society for Heart and Lung Transplantation (ISHLT) biopsy scale classifies cellular and antibody-mediated rejections. However, there are cases with acute decline in left ventricular ejection fraction (LVEF ≤ 45%) but no evidence of rejection on biopsy. Characteristics and treatment response of this biopsy negative rejection (BNR) have yet to be elucidated. Methods. Between 2002 and 2012, we found 12 cases of BNR in 11 heart transplant patients as previously defined. One of the 11 patients was treated a second time for BNR. Characteristics and response to treatment were noted. Results. 12 cases (of 11 patients) were reviewed and 11 occurred during the first year after transplant. 8 cases without heart failure symptoms were treated with an oral corticosteroids bolus and taper or intravenous immunoglobulin. Four cases with heart failure symptoms were treated with thymoglobulin, intravenous immunoglobulin, and intravenous methylprednisolone followed by an oral corticosteroids bolus and taper. Overall, 7 cases resulted in return to normal left ventricular function within a mean of 14 ± 10 days from the initial biopsy. Conclusion. BNR includes cardiac dysfunction and can be a severe form of rejection. Characteristics of these cases of rejection are described with most cases responding to appropriate therapy.

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The ISHLT working formulation for pathologic diagnosis of antibody-mediated rejection in heart transplantation: Evolution and current status (2005–2011)

Cited by 200 publications

References 46 publications

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

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

Antibody Mediated Rejection of the Cardiac Allograft

683 The Natural History of Biopsy Negative Rejection after Heart Transplantation

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