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

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:30

Article

Kobashigawa, Jon¹  Crespo-Leiro, Maria G.²  Ensminger, Stephan M.³  Reichenspurner, Hermann⁴  Angelini, Annalisa⁵  Berry, Gerald⁶  Burke, Margaret⁷  Czer, Lawrence⁸  Hiemann, Nicola⁹  Kfoury, Abdallah G.¹⁰  Mancini, Donna¹¹  Mohacsi, Paul¹²  Patel, Jignesh¹  Pereira, Naveen¹³  Platt, Jeffrey L.¹⁴  Reed, Elaine F.¹⁵  Reinsmoen, Nancy¹⁶  Rodriguez, E. Rene¹⁷  Rose, Marlene L.⁷  Russell, Stuart D.¹⁸  Starling, Randy¹⁷  Suciu-Foca, Nicole¹⁹  Tallaj, Jose²⁰  Taylor, David O.¹⁷  Van Bakel, Adrian²¹  West, Lori²²  Zeevi, Adriana²³  Zuckermann, Andreas²⁴ 

[1] Cedars Sinai Heart Inst, Los Angeles, CA 90048 USA

[2] Hosp Univ A Coruna, Coruna, Spain

[3] Univ Erlangen Nurnberg, Nurnberg, Germany

[4] Univ Hosp Eppendorf, Hamburg, Germany

[5] Univ Padua, Padua, Italy

[6] Stanford Univ, Stanford, CA 94305 USA

[7] Harefield Hosp, Harefield, Middx, England

[8] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[9] Deutsch Herzzentrum Berlin, Berlin, Germany

[10] Intermt Med Ctr, Salt Lake City, UT USA

[11] Columbia Presbyterian Med Ctr, New York, NY 10032 USA

[12] Inselspital Bern, Univ Hosp Bern, CH-3010 Bern, Switzerland

[13] Mayo Clin, Minneapolis, MN USA

[14] Univ Michigan, Ann Arbor, MI 48109 USA

[15] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA

[16] Cedars Sinai Comprehens Transplant Ctr, Los Angeles, CA USA

[17] Cleveland Clin, Cleveland, OH 44106 USA

[18] Johns Hopkins Univ Hosp, Baltimore, MD 21287 USA

[19] Columbia Univ Coll Phys & Surg, New York, NY 10032 USA

[20] Univ Alabama Birmingham, Birmingham, AL USA

[21] Med Univ S Carolina, Charleston, SC 29425 USA

[22] Univ Alberta, Edmonton, AB, Canada

[23] Univ Pittsburgh, Pittsburgh, PA USA

[24] Med Univ Vienna, Vienna, Austria

关键词: heart transplant;    antibody;    rejection;    treatment;    outcomes;   

DOI  :  10.1016/j.healun.2010.11.003

来源: Elsevier

【 摘 要 】

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. J Heart Lung Transplant 2011;30:252-69 (C) 2011 International Society for Heart and Lung Transplantation All rights reserved.

【 授权许可】

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