Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation

Deborah J Levine¹, Allan R Glanville², Christina Aboyoun³, John Belperio⁴, Christian Benden⁵, Gerald J Berry⁶, Ramsey Hachem⁷, Don Hayes Jr⁸, Desley Neil⁹, Nancy L Reinsmoen¹⁰, Laurie D Snyder¹¹, Stuart Sweet⁷, Dolly Tyan⁶, Geert Verleden¹², Glen Westall¹³, Roger D Yusen⁷, Martin Zamora¹⁴, Adriana Zeevi¹⁵

Affiliations

¹ Pulmonary Disease and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
² The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia. Electronic address: allan.glanville@svha.org.au.
³ The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia.
⁴ Pulmonary Disease and Critical Care Medicine, University of California, Los Angeles, California, USA.
⁵ Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
⁶ Division of Pathology, Stanford University Medical Center, Palo Alto, California, USA.
⁷ Division of Pulmonology, Washington University, St. Louis, Missouri, USA.
⁸ Department of Pulmonology, The Ohio State University, Columbus, Ohio, USA.
⁹ Department of Pathology, Queen Elizabeth Hospital, Birmingham, UK.
¹⁰ Department of Immunology, Cedars-Sinai Hospital, Los Angeles, California, USA.
¹¹ Department of Pulmonology, Duke University, Durham, North Carolina, USA.
¹² Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium.
¹³ Department of Pulmonology, Alfred Hospital, Melbourne, Victoria, Australia.
¹⁴ Department of Pulmonology, University of Colorado, Denver, Colorado, USA.
¹⁵ Department of Immunology, University of Pittsburgh, Pittsburgh, Pennyslvania, USA.

PMID: 27044531
DOI: 10.1016/j.healun.2016.01.1223

Review

Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation

Deborah J Levine et al. J Heart Lung Transplant. 2016 Apr.

. 2016 Apr;35(4):397-406.

doi: 10.1016/j.healun.2016.01.1223. Epub 2016 Feb 10.

Authors

Affiliations

¹ Pulmonary Disease and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
² The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia. Electronic address: allan.glanville@svha.org.au.
³ The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia.
⁴ Pulmonary Disease and Critical Care Medicine, University of California, Los Angeles, California, USA.
⁵ Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
⁶ Division of Pathology, Stanford University Medical Center, Palo Alto, California, USA.
⁷ Division of Pulmonology, Washington University, St. Louis, Missouri, USA.
⁸ Department of Pulmonology, The Ohio State University, Columbus, Ohio, USA.
⁹ Department of Pathology, Queen Elizabeth Hospital, Birmingham, UK.
¹⁰ Department of Immunology, Cedars-Sinai Hospital, Los Angeles, California, USA.
¹¹ Department of Pulmonology, Duke University, Durham, North Carolina, USA.
¹² Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium.
¹³ Department of Pulmonology, Alfred Hospital, Melbourne, Victoria, Australia.
¹⁴ Department of Pulmonology, University of Colorado, Denver, Colorado, USA.
¹⁵ Department of Immunology, University of Pittsburgh, Pittsburgh, Pennyslvania, USA.

PMID: 27044531
DOI: 10.1016/j.healun.2016.01.1223

Abstract

Antibody-mediated rejection (AMR) is a recognized cause of allograft dysfunction in lung transplant recipients. Unlike AMR in other solid-organ transplant recipients, there are no standardized diagnostic criteria or an agreed-upon definition. Hence, a working group was created by the International Society for Heart and Lung Transplantation with the aim of determining criteria for pulmonary AMR and establishing a definition. Diagnostic criteria and a working consensus definition were established. Key diagnostic criteria include the presence of antibodies directed toward donor human leukocyte antigens and characteristic lung histology with or without evidence of complement 4d within the graft. Exclusion of other causes of allograft dysfunction increases confidence in the diagnosis but is not essential. Pulmonary AMR may be clinical (allograft dysfunction which can be asymptomatic) or sub-clinical (normal allograft function). This consensus definition will have clinical, therapeutic and research implications.

Keywords: HLA antibodies; allograft dysfunction; lung transplantation; rejection.

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Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation

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Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation

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