Report from a consensus conference on antibody-mediated rejection in heart transplantation
Jon Kobashigawa, Maria G Crespo-Leiro, Stephan M Ensminger, Hermann Reichenspurner, Annalisa Angelini, Gerald Berry, Margaret Burke, Lawrence Czer, Nicola Hiemann, Abdallah G Kfoury, Donna Mancini, Paul Mohacsi, Jignesh Patel, Naveen Pereira, Jeffrey L Platt, Elaine F Reed, Nancy Reinsmoen, E Rene Rodriguez, Marlene L Rose, Stuart D Russell, Randy Starling, Nicole Suciu-Foca, Jose Tallaj, David O Taylor, Adrian Van Bakel, Lori West, Adriana Zeevi, Andreas Zuckermann, Consensus Conference Participants, Juan Alejos, Annalisa Angelini, William Baldwin 3rd, David Baran, Eduardo Barge-Caballero, Gerald Berry, Patrick Bruneval, Deborah Budge, Margaret Burke, Charles E Canter, Patricia P Chang, Monica Colvin-Adams, Maria Costanzo, Maria G Crespo-Leiro, Lawrence Czer, Teresa De Marco, Juan Delgado Jimenez, Mark Drazner, Brooks S Edwards, Howard J Eisen, Stephan M Ensminger, Savitri Fedson, David Feldman, Giuseppe Feltrin, Michael C Fishbein, H Edward Garrett, James F George, Michael M Givertz, Lee Goldberg, Mark Haas, Elizabeth Hammond, Sharon Hunt, Maryl R Johnson, Andrew Kao, Ronald H Kerman, Abdallah G Kfoury, Michael Kiernan, James Kirklin, Michelle Kittleson, Jon Kobashigawa, Robert L Kormos, Mary Leffell, JoAnn Lindenfeld, Donna M Mancini, Mandeep R Mehra, Dylan Miller, Paul Mohacsi, Thalachallour Mohanakumar, Takeshi Nakatani, Desley Neil, Jignesh K Patel, Samuel Pepkowitz, Naveen L Pereira, Michael Pham, Barbara Pisani, Jeffrey L Platt, Elaine F Revelo, E Rene Rodriguez, Joseph G Rogers, Marlene L Rose, Eulalia Roig, Bruce Rosengard, Stuart D Russell, Javier Segovia, Mario Sénéchal, Susan Stewart, Nicole Suciu-Foca, Jose Tallaj, Anat R Tambur, Carmela D Tan, David O Taylor, Jeffrey Teuteberg, Dolly Tyan, Patricia Uber, Walter Uber, Adrian B Van Bakel, Johan Vanhaecke, Steve Webber, Lori J West, Gayle L Winters, Andrea A Zachary, Adriana Zeevi, Andreas Zuckermann, Jon Kobashigawa, Maria G Crespo-Leiro, Stephan M Ensminger, Hermann Reichenspurner, Annalisa Angelini, Gerald Berry, Margaret Burke, Lawrence Czer, Nicola Hiemann, Abdallah G Kfoury, Donna Mancini, Paul Mohacsi, Jignesh Patel, Naveen Pereira, Jeffrey L Platt, Elaine F Reed, Nancy Reinsmoen, E Rene Rodriguez, Marlene L Rose, Stuart D Russell, Randy Starling, Nicole Suciu-Foca, Jose Tallaj, David O Taylor, Adrian Van Bakel, Lori West, Adriana Zeevi, Andreas Zuckermann, Consensus Conference Participants, Juan Alejos, Annalisa Angelini, William Baldwin 3rd, David Baran, Eduardo Barge-Caballero, Gerald Berry, Patrick Bruneval, Deborah Budge, Margaret Burke, Charles E Canter, Patricia P Chang, Monica Colvin-Adams, Maria Costanzo, Maria G Crespo-Leiro, Lawrence Czer, Teresa De Marco, Juan Delgado Jimenez, Mark Drazner, Brooks S Edwards, Howard J Eisen, Stephan M Ensminger, Savitri Fedson, David Feldman, Giuseppe Feltrin, Michael C Fishbein, H Edward Garrett, James F George, Michael M Givertz, Lee Goldberg, Mark Haas, Elizabeth Hammond, Sharon Hunt, Maryl R Johnson, Andrew Kao, Ronald H Kerman, Abdallah G Kfoury, Michael Kiernan, James Kirklin, Michelle Kittleson, Jon Kobashigawa, Robert L Kormos, Mary Leffell, JoAnn Lindenfeld, Donna M Mancini, Mandeep R Mehra, Dylan Miller, Paul Mohacsi, Thalachallour Mohanakumar, Takeshi Nakatani, Desley Neil, Jignesh K Patel, Samuel Pepkowitz, Naveen L Pereira, Michael Pham, Barbara Pisani, Jeffrey L Platt, Elaine F Revelo, E Rene Rodriguez, Joseph G Rogers, Marlene L Rose, Eulalia Roig, Bruce Rosengard, Stuart D Russell, Javier Segovia, Mario Sénéchal, Susan Stewart, Nicole Suciu-Foca, Jose Tallaj, Anat R Tambur, Carmela D Tan, David O Taylor, Jeffrey Teuteberg, Dolly Tyan, Patricia Uber, Walter Uber, Adrian B Van Bakel, Johan Vanhaecke, Steve Webber, Lori J West, Gayle L Winters, Andrea A Zachary, Adriana Zeevi, Andreas Zuckermann
Abstract
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.
Copyright © 2011 International Society for Heart and Lung Transplantation. All rights reserved.
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Source: PubMed