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

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• 作者：Jon Kobashigawa MD^a ; ^{kobashigawaj@cshs.org} ; Maria G. Crespo-Leiro MD^b ; Stephan M. Ensminger MD^c ; Hermann Reichenspurner MD ; PhD^d ; Annalisa Angelini MD^e ; Gerald Berry MD^f ; Margaret Burke MD^g ; Lawrence Czer MD^h ; Nicola Hiemann MDⁱ ; Abdallah G. Kfoury MD^j ; Donna Mancini MD^k ; Paul Mohacsi MD^l ; Jignesh Patel MD ; PhD^a ; Naveen Pereira MD^m ; Jeffrey L. Platt MDⁿ ; Elaine F. Reed PhD^o ; Nancy Reinsmoen PhD^p ; E. Rene Rodriguez MD^q ; Marlene L. Rose PhD^g ; Stuart D. Russell MD^r ; Randy Starling MD ; MPH^q ; Nicole Suciu-Foca PhD^s ; Jose Tallaj MD^t ; David O. Taylor MD^q ; Adrian Van Bakel MD ; PhD^u ; Lori West MD^v ; Adriana Zeevi PhD^w ; Andreas Zuckermann MD^x ; Consensus Conference Participants
• 关键词：heart transplant ; antibody ; rejection ; treatment ; outcomes
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2011
• 出版时间：March 2011
• 年：2011
• 卷：30
• 期：3
• 页码：252-269
• 全文大小：661 K

文摘

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.