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

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• 作者：Deborah J. Levine ; MD^a ; Allan R. Glanville ; MBBS ; MD^b ; ^{allan.glanville@svha.org.au" class="auth_mail" title="E-mail the corresponding author} ; Christina Aboyoun ; BA ; MBA^b ; John Belperio ; MD^c ; Christian Benden ; MD ; FCCP^d ; Gerald J. Berry ; MD^e ; Ramsey Hachem ; MD^f ; Don Hayes ; Jr. ; MD ; MS^g ; Desley Neil ; MBBS ; PhD^h ; Nancy L. Reinsmoen ; PhD ; D(ABHI)ⁱ ; Laurie D. Snyder ; MD^j ; Stuart Sweet ; MD ; PhD^f ; Dolly Tyan ; PhD^e ; Geert Verleden ; MD ; PhD^k ; Glen Westall ; MBBS ; PhD^l ; Roger D. Yusen ; MD ; MPH^f ; Martin Zamora ; MD^m ; Adriana Zeevi ; PhDⁿ
• 关键词：lung transplantation ; rejection ; HLA antibodies ; allograft dysfunction
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：35
• 期：4
• 页码：397-406
• 全文大小：1041 K

文摘

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.