Open AccessJournal Article
Vascular (humoral) rejection in heart transplantation: pathologic observations and clinical implications.
Elizabeth H. Hammond,Yowell Rl,Nunoda S,Ronald L. Menlove,Dale G. Renlund,Michael R. Bristow,Kent W. Jones,John B. O'Connell +7 more
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TLDR
It is concluded that immunofluorescence should be routinely done on all heart biopsies for the first month after transplantation, because patients with vascular (humoral) rejection cannot be reliably identified by any other means.Abstract:
We prospectively studied 551 sequential endomyocardial biopsies from 36 consecutive cardiac allografts. With the use of a combination of light microscopy (including careful evaluation of vascular changes) and immunofluorescence to detect the deposition of immunoglobulin and complement, we identified three patterns of allograft rejection, designated as cellular rejection, vascular (humoral) rejection, and mixed rejection. Cellular rejection was diagnosed with modified Billingham criteria. Vascular rejection was diagnosed by finding the combination of prominent endothelial cell swelling and/or vasculitis on light microscopy and the vascular deposition of immunoglobulin and complement by immunofluorescence. In such patients, cellular lymphoid infiltrates were uniformly absent at the time the vascular changes were detected. Mixed rejection consisted of findings of both cellular and vascular rejection occurring simultaneously. Twenty of 36 allografts exhibited cellular rejection; seven allografts showed vascular rejection, and nine allografts developed mixed rejection. The vascular (humoral) pattern of rejection was important to identify because the patients with this type of rejection had a significantly decreased survival compared with that of patients with cellular rejection (p less than 0.05). Survival in the mixed rejection category was intermediate. Positive donor-specific cross-match and/or panel-reactive antibody greater than or equal to 5% and systolic dysfunction were seen in three of the seven allografts with vascular (humoral) rejection but not in the other types. In the early period after transplant (up to 3 weeks after transplant), the only reliable identifying characteristics of patients with vascular (humoral) rejection were the presence of vascular immunoglobulin and complement assessed by immunofluorescence and endothelial cell swelling and interstitial edema as confirmed by histologic examination. We conclude that immunofluorescence should be routinely done on all heart biopsies for the first month after transplantation. Patients with vascular (humoral) rejection cannot be reliably identified by any other means.read more
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Journal ArticleDOI
Revision of the 1990 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Heart Rejection
Susan Stewart,Michael C. Fishbein,G.I. Snell,Gerald J. Berry,Annette Boehler,Margaret Burke,A. Glanville,F. Kate Gould,Cynthia Magro,Charles C. Marboe,K. McNeil,Elaine F. Reed,Nancy L. Reinsmoen,John P. Scott,Sean M. Studer,Henry D. Tazelaar,John Wallwork,G.P. Westall,Martin Zamora,Adriana Zeevi,Samuel A. Yousem +20 more
TL;DR: This article summarizes the revised consensus classification of lung allograft rejection and recommends the evaluation of antibody-mediated rejection, recognizing that this is a controversial entity in the lung, less well developed and understood than in other solid-organ grafts, and with no consensus reached on diagnostic features.
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Antibody-mediated rejection criteria - an addition to the Banff 97 classification of renal allograft rejection.
Lorraine C. Racusen,Robert B. Colvin,Kim Solez,Michael J. Mihatsch,Philip F. Halloran,Patricia Campbell,Michael Cecka,Jean Pierre Cosyns,Anthony J. Demetris,Michael C. Fishbein,Agnes B. Fogo,Peter N. Furness,Ian W. Gibson,Denis Glotz,Pekka Häyry,Lawrence Hunsickern,Michael Kashgarian,Ronald H. Kerman,Alex J. Magil,Robert A. Montgomery,Kunio Morozumi,Volker Nickeleit,Parmjeet Randhawa,Heinz Regele,Daniel Serón,Surya V. Seshan,Stale Sund,Kiril Trpkov +27 more
TL;DR: This article presents international consensus criteria for and classification of AbAR developed based on discussions held at the Sixth Banff Conference on Allograft Pathology in 2001, to be revisited as additional data accumulate in this important area of renal transplantation.
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Antibody-mediated organ-allograft rejection
Robert B. Colvin,R. Neal Smith +1 more
TL;DR: Antibody induces rejection acutely through the fixation of complement, resulting in tissue injury and coagulation, and complement activation recruits macrophages and neutrophils, causing additional endothelial injury.
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The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation
Gerald J. Berry,Margaret Burke,Claus B. Andersen,Patrick Bruneval,Marny Fedrigo,Michael C. Fishbein,Martin Goddard,Elizabeth H. Hammond,Ornella Leone,Charles C. Marboe,Dylan V. Miller,Desley Neil,Doris Rassl,Monica P. Revelo,Alexandra Rice,E. Rene Rodriguez,Susan Stewart,Carmela D. Tan,Gayle L. Winters,Lori J. West,Mandeep R. Mehra,Annalisa Angelini +21 more
TL;DR: The consensus findings from a series of meetings held between 2010-2012 to develop a Working Formulation for the pathologic diagnosis, grading, and reporting of cardiac antibody-mediated rejection are reported.
Journal ArticleDOI
2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology
Ornella Leone,John P. Veinot,Annalisa Angelini,Ulrik Baandrup,Cristina Basso,Gerald J. Berry,Patrick Bruneval,Margaret Burke,Jagdish Butany,Fiorella Calabrese,Giulia d'Amati,William D. Edwards,John T. Fallon,Michael C. Fishbein,Patrick J. Gallagher,Marc K. Halushka,Bruce M. McManus,Angela Pucci,E. Rene Rodriguez,Jeffrey E. Saffitz,Mary N. Sheppard,Charles Steenbergen,James R. Stone,Carmela D. Tan,Gaetano Thiene,Allard C. van der Wal,Gayle L. Winters +26 more
TL;DR: Determining appropriate EMB use in the context of current diagnostic strategies for cardiac diseases and providing recommendations for its rational utilization and providing standard criteria and guidance for appropriate tissue triage and pathological analysis is suggested.
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