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 language | English |
|---|---|
| Journal | Journal of Heart and Lung Transplantation |
| Volume | 30 |
| Issue number | 3 |
| Pages (from-to) | 252-269 |
| Number of pages | 18 |
| ISSN | 1053-2498 |
| DOIs | |
| Publication status | Published - 03.2011 |
Funding
This conference was jointly funded by the ISHLT and the Cedars-Sinai Heart Institute . Jon Kobashigawa, MD: research grants and advisory board for Novartis ; Maria G. Crespo-Leiro, MD: research grants from Novartis , Wyeth , Roche , and Astellas Pharma ; Hermann Reichenspurner, MD, PhD: one travel grant from Novartis ; Nicola Hiemann, MD: research grants from the German Research Foundation , the Will Foundation , and Novartis , advisory board for Novartis; Abdallah G. Kfoury, MD: research grants from Novartis and XDx Inc. ; Donna Mancini, MD: consultant to Celladon, Inc; Paul Mohacsi, MD: Grant/research support from Roche , and consultant/scientific advisor to Astellas, Thoratec, Novartis, and XDx; Jignesh Patel, MD, PhD: research grants from Novartis ; Elaine F. Reed, PhD: NIH research grants related to the study of antibody-mediated graft rejection; E. Rene Rodriguez, MD: consulted for Glaxo-Smith-Kline on antibody-mediated rejection; Marlene L. Rose, PhD: employed by Imperial College (possesses Intellectual Property Rights on vimentin as a marker of rejection); Randall Starling, MD, MPH: research grants and advisory board for Novartis ; David O. Taylor, MD: Sub-investigator for clinical research study for XDx and Novartis; Adrian Van Bakel, MD, PhD: research grants from Novartis ; Andreas Zuckermann, MD: scientific grant and speakers bureau for Genzyme , scientific grant and speakers bureau for Novartis , scientific grant for Roche , and scientific grant for Wyeth ; advisory board and speakers' bureau for Astellas .
