Antibody-Mediated Rejection of the Lung

Published 10 February 2016

Deborah J. Levine, MD; Allan R. Glanville, MBBS, MD; Christina Aboyoun, BA, MBA; John Belperio, MD; Christian Benden, MD, FCCP; Gerald J. Berry, MD; Ramsey Hachem, MD; Don Hayes, Jr., MD, MS; Desley Neil, MBBS, PhD; Nancy L. Reinsmoen, PhD, D(ABHI); Laurie D. Snyder, MD; Stuart Sweet, MD, PhD; Dolly Tyan, PhD; Geert Verleden, MD, PhD; Glen Westall, MBBS, PhD; Roger D. Yusen, MD, MPH; Martin Zamora, MD; Adriana Zeevi, PhD

J Heart Lung Transplant. 2016 Apr;35(4):397-406

• Advanced Lung Failure & Transplantation
• Cardiothoracic Surgery
• Consensus Document
• Pediatrics
• Publications & Journals
• Pulmonology
• Standards & Guidelines

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.

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).

The primary aim of this document is to provide a consensus on a formal working definition of pulmonary AMR. This consensus definition will have clinical, therapeutic and research implications. Secondary goals are to propose phenotypes of pulmonary AMR and identify knowledge gaps on topics related to pulmonary AMR to direct clinical evaluation and future research.

Read at JHLT

Download Figures