Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 7, Issue 9, Pages 2064-2074Publisher
WILEY
DOI: 10.1111/j.1600-6143.2007.01900.x
Keywords
antibody-mediated rejection; complications; diagnosis; heart transplantation; immunosuppressive therapy; transplant coronary artery disease
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Acute antibody-mediated rejection (AMR) in heart transplantation is often associated with hemodynamic compromise, and is associated with increased mortality and development of accelerated transplant coronary artery disease (TCAD). The diagnosis of AMR has historically been controversial and outcomes with aggressive immunosuppressive therapy including plasmapheresis and cyclophosphamide are poor. Advances in diagnostic techniques like the demonstration of immunopathologic evidence for antibody-mediated rejection by deposition of the complement split product C4d in tissue and detection of anti-HLA antibodies by flow cytometry will assist in further characterizing AMR. Immunosuppression targeting B-lymphocytes and use of m-TOR inhibitors to alter the predilection to develop TCAD and improve survival in AMR remains to be proven.
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