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

TY - JOUR

T1 - Report from a consensus conference on antibody-mediated rejection in heart transplantation

AU - Kobashigawa, Jon

AU - Crespo-Leiro, Maria G

AU - Ensminger, Stephan M

AU - Reichenspurner, Hermann

AU - Angelini, Annalisa

AU - Berry, Gerald

AU - Burke, Margaret

AU - Czer, Lawrence

AU - Hiemann, Nicola

AU - Kfoury, Abdallah G

AU - Mancini, Donna

AU - Mohacsi, Paul

AU - Patel, Jignesh

AU - Pereira, Naveen

AU - Platt, Jeffrey L

AU - Reed, Elaine F

AU - Reinsmoen, Nancy

AU - Rodriguez, E Rene

AU - Rose, Marlene L

AU - Russell, Stuart D

AU - Starling, Randy

AU - Suciu-Foca, Nicole

AU - Tallaj, Jose

AU - Taylor, David O

AU - Van Bakel, Adrian

AU - West, Lori

AU - Zeevi, Adriana

AU - Zuckermann, Andreas

AU - Consensus Conference participants

N1 - Copyright © 2011 International Society for Heart and Lung Transplantation. All rights reserved.

PY - 2011/3

Y1 - 2011/3

N2 - 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.

AB - 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.

KW - Antibodies/blood

KW - Graft Rejection/immunology

KW - Heart Transplantation/immunology

KW - Humans

KW - Treatment Outcome

U2 - 10.1016/j.healun.2010.11.003

DO - 10.1016/j.healun.2010.11.003

M3 - SCORING: Journal article

C2 - 21300295

VL - 30

SP - 252

EP - 269

JO - J HEART LUNG TRANSPL

JF - J HEART LUNG TRANSPL

SN - 1053-2498

IS - 3

ER -