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.
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.
Authors: N Suciu-Foca; E Reed; C Marboe; P Harris; P X Yu; Y K Sun; E Ho; E Rose; K Reemtsma; D W King Journal: Transplantation Date: 1991-03 Impact factor: 4.939
Authors: M J Dunn; M L Rose; N Latif; S Bradd; C Lovegrove; C Seymour; A Pomerance; M H Yacoub Journal: Transplantation Date: 1991-04 Impact factor: 4.939
Authors: Maria G Crespo-Leiro; Alberto Veiga-Barreiro; Nieves Doménech; Maria J Paniagua; Pablo Piñón; Margarita González-Cuesta; Eduardo Vázquez-Martul; Consuelo Ramirez; Jose J Cuenca; Alfonso Castro-Beiras Journal: Am J Transplant Date: 2005-10 Impact factor: 8.086
Authors: R Sberro-Soussan; J Zuber; C Suberbielle-Boissel; S Candon; F Martinez; R Snanoudj; M Rabant; N Pallet; D Nochy; D Anglicheau; M Leruez; A Loupy; E Thervet; O Hermine; C Legendre Journal: Am J Transplant Date: 2010-02-01 Impact factor: 8.086
Authors: J S Ladowski; T Dillon; M H Schatzlein; A C Peterson; W P Deschner; L Beatty; M Sullivan; R H Scheeringa; W R Clark Journal: J Cardiovasc Surg (Torino) Date: 1993-04 Impact factor: 1.888
Authors: R M Ratkovec; E H Hammond; J B O'Connell; M R Bristow; C W DeWitt; W E Richenbacher; R C Millar; D G Renlund Journal: Transplantation Date: 1992-10 Impact factor: 4.939
Authors: Lili Zhang; Maeve Jones-O'Connor; Magid Awadalla; Daniel A Zlotoff; Paaladinesh Thavendiranathan; John D Groarke; Alexandra-Chloe Villani; Alexander R Lyon; Tomas G Neilan Journal: Curr Treat Options Cardiovasc Med Date: 2019-06-08
Authors: Nitin Chanana; Charlotte S Van Dorn; Melanie D Everitt; Hsin Yi Weng; Dylan V Miller; Shaji C Menon Journal: Pediatr Cardiol Date: 2017-02-04 Impact factor: 1.655
Authors: Oluwatoyosi A Onwuemene; Steven C Grambow; Chetan B Patel; Robert J Mentz; Carmelo A Milano; Joseph G Rogers; Ara D Metjian; Gowthami M Arepally; Thomas L Ortel Journal: J Clin Apher Date: 2018-03-10 Impact factor: 2.821
Authors: Esme I Dijke; Jeffrey L Platt; Paul Blair; Menna R Clatworthy; Jignesh K Patel; A G Kfoury; Marilia Cascalho Journal: J Heart Lung Transplant Date: 2016-02-12 Impact factor: 10.247