Diagnosis of acute cellular rejection and antibody-mediated rejection on lung transplant biopsies: A perspective from members of the pulmonary pathology society

Anja C. Roden, Dara L. Aisner, Timothy Craig Allen, Marie Christine Aubry, Roberto J. Barrios, Mary B. Beasley, Philip T. Cagle, Vera L. Capelozzi, Sanja Dacic, Yimin Ge, Lida P. Hariri, Sylvie Lantuejoul, Ross A. Miller, Mari Mino-Kenudson, Andre L. Moreira, Kirtee Raparia, Natasha Rekhtman, Lynette Sholl, Maxwell L. Smith, Ming S. TsaoMarina Vivero, Yasushi Yatabe, Eunhee S. Yi

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Context.-The diagnosis and grading of acute cellular and antibody-mediated rejection (AMR) in lung allograft biopsies is important because rejection can lead to acute graft dysfunction and/or failure and may contribute to chronic graft failure. While acute cellular rejection is well defined histologically, no reproducible specific features of AMR are currently identified. Therefore, a combination of clinical features, serology, histopathology, and immunologic findings is suggested for the diagnosis of AMR. Objective.-To describe the perspective of members of the Pulmonary Pathology Society (PPS) on the workup of lung allograft transbronchial biopsy and the diagnosis of acute cellular rejection and AMR in lung transplant. Data Sources.-Reports by the International Society for Heart and Lung Transplantation (ISHLT), experience of members of PPS who routinely review lung allograft biopsies, and search of literature database (PubMed). Conclusions.-Acute cellular rejection should be assessed and graded according to the 2007 working formulation of the ISHLT. As currently no specific features are known for AMR in lung allografts, the triple test (clinical allograft dysfunction, donor-specific antibodies, pathologic findings) should be used for its diagnosis. C4d staining might be performed when morphologic, clinical, and/or serologic features suggestive of AMR are identified.

Original languageEnglish (US)
Pages (from-to)437-444
Number of pages8
JournalArchives of Pathology and Laboratory Medicine
Volume141
Issue number3
DOIs
StatePublished - Mar 2017

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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