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 Luke Pereira, Jeffrey L. Platt, Elaine F. Reed, Nancy Reinsmoen, E. Rene Rodriguez, Marlene L. Rose, Stuart D. Russell & 8 others Randy Starling, Nicole Suciu-Foca, Jose Tallaj, David O. Taylor, Adrian Van Bakel, Lori West, Adriana Zeevi, Andreas Zuckermann

Research output: Contribution to journalArticle

212 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)252-269
Number of pages18
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Heart Transplantation
Antibodies
Tissue Donors
Northern Asia
Pathology
Transplants
Biopsy
North America
Allografts

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Kobashigawa, J., Crespo-Leiro, M. G., Ensminger, S. M., Reichenspurner, H., Angelini, A., Berry, G., ... Zuckermann, A. (2011). Report from a consensus conference on antibody-mediated rejection in heart transplantation. Journal of Heart and Lung Transplantation, 30(3), 252-269. https://doi.org/10.1016/j.healun.2010.11.003

Report from a consensus conference on antibody-mediated rejection in heart transplantation. / Kobashigawa, Jon; Crespo-Leiro, Maria G.; Ensminger, Stephan M.; Reichenspurner, Hermann; Angelini, Annalisa; Berry, Gerald; Burke, Margaret; Czer, Lawrence; Hiemann, Nicola; Kfoury, Abdallah G.; Mancini, Donna; Mohacsi, Paul; Patel, Jignesh; Pereira, Naveen Luke; Platt, Jeffrey L.; Reed, Elaine F.; Reinsmoen, Nancy; Rodriguez, E. Rene; Rose, Marlene L.; Russell, Stuart D.; Starling, Randy; Suciu-Foca, Nicole; Tallaj, Jose; Taylor, David O.; Van Bakel, Adrian; West, Lori; Zeevi, Adriana; Zuckermann, Andreas.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 3, 03.2011, p. 252-269.

Research output: Contribution to journalArticle

Kobashigawa, J, Crespo-Leiro, MG, Ensminger, SM, Reichenspurner, H, Angelini, A, Berry, G, Burke, M, Czer, L, Hiemann, N, Kfoury, AG, Mancini, D, Mohacsi, P, Patel, J, Pereira, NL, Platt, JL, Reed, EF, Reinsmoen, N, Rodriguez, ER, Rose, ML, Russell, SD, Starling, R, Suciu-Foca, N, Tallaj, J, Taylor, DO, Van Bakel, A, West, L, Zeevi, A & Zuckermann, A 2011, 'Report from a consensus conference on antibody-mediated rejection in heart transplantation', Journal of Heart and Lung Transplantation, vol. 30, no. 3, pp. 252-269. https://doi.org/10.1016/j.healun.2010.11.003
Kobashigawa J, Crespo-Leiro MG, Ensminger SM, Reichenspurner H, Angelini A, Berry G et al. Report from a consensus conference on antibody-mediated rejection in heart transplantation. Journal of Heart and Lung Transplantation. 2011 Mar;30(3):252-269. https://doi.org/10.1016/j.healun.2010.11.003
Kobashigawa, Jon ; Crespo-Leiro, Maria G. ; Ensminger, Stephan M. ; Reichenspurner, Hermann ; Angelini, Annalisa ; Berry, Gerald ; Burke, Margaret ; Czer, Lawrence ; Hiemann, Nicola ; Kfoury, Abdallah G. ; Mancini, Donna ; Mohacsi, Paul ; Patel, Jignesh ; Pereira, Naveen Luke ; Platt, Jeffrey L. ; Reed, Elaine F. ; Reinsmoen, Nancy ; Rodriguez, E. Rene ; Rose, Marlene L. ; Russell, Stuart D. ; Starling, Randy ; Suciu-Foca, Nicole ; Tallaj, Jose ; Taylor, David O. ; Van Bakel, Adrian ; West, Lori ; Zeevi, Adriana ; Zuckermann, Andreas. / Report from a consensus conference on antibody-mediated rejection in heart transplantation. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 3. pp. 252-269.
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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.",
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AU - Crespo-Leiro, Maria G.

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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 Luke

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

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