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. 2011 Mar;30(3):252-69.
doi: 10.1016/j.healun.2010.11.003.

Report from a consensus conference on antibody-mediated rejection in heart transplantation

Jon Kobashigawa  1 , Maria G Crespo-Leiro, Stephan M Ensminger, Hermann Reichenspurner, Annalisa Angelini, Gerald Berry, Margaret Burke, Lawrence Czer, Nicola Hiemann, Abdallah G Kfoury, Donna Mancini, Paul Mohacsi, Jignesh Patel, Naveen Pereira, Jeffrey L Platt, Elaine F Reed, Nancy Reinsmoen, E Rene Rodriguez, Marlene L Rose, Stuart D Russell, Randy Starling, Nicole Suciu-Foca, Jose Tallaj, David O Taylor, Adrian Van Bakel, Lori West, Adriana Zeevi, Andreas Zuckermann; Consensus Conference Participants
Collaborators, Affiliations

Report from a consensus conference on antibody-mediated rejection in heart transplantation

Jon Kobashigawa et al. J Heart Lung Transplant. 2011 Mar.

Abstract

Background: The problem of AMR remains unsolved because standardized schemes for diagnosis and treatment remains contentious. Therefore, a consensus conference was organized to discuss the current status of antibody-mediated rejection (AMR) in heart transplantation.

Methods: The conference included 83 participants (transplant cardiologists, surgeons, immunologists and pathologists) representing 67 heart transplant centers from North America, Europe, and Asia who all participated in smaller break-out sessions to discuss the various topics of AMR and attempt to achieve consensus.

Results: A tentative pathology diagnosis of AMR was established, however, the pathologist felt that further discussion was needed prior to a formal recommendation for AMR diagnosis. One of the most important outcomes of this conference was that a clinical definition for AMR (cardiac dysfunction and/or circulating donor-specific antibody) was no longer believed to be required due to recent publications demonstrating that asymptomatic (no cardiac dysfunction) biopsy-proven AMR is associated with subsequent greater mortality and greater development of cardiac allograft vasculopathy. It was also noted that donor-specific antibody is not always detected during AMR episodes as the antibody may be adhered to the donor heart. Finally, recommendations were made for the timing for specific staining of endomyocardial biopsy specimens and the frequency by which circulating antibodies should be assessed. Recommendations for management and future clinical trials were also provided.

Conclusions: The AMR Consensus Conference brought together clinicians, pathologists and immunologists to further the understanding of AMR. Progress was made toward a pathology AMR grading scale and consensus was accomplished regarding several clinical issues.

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Figures

Figure 1
Figure 1
Previously proposed algorithm describes a therapeutic approach to the treatment of antibody-mediated rejection (AMR) in heart transplant recipients. ATG, anti-thymocyte globulin; DSA, donor-specific antibodies; IV, intravenous; IVIg, intravenous immune globulin; IVUS, intravascular ultrasound. Reprinted from the American Journal of Transplantation with permission from John Wiley and Sons.
See this image and copyright information in PMC

References

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