Antibody-Mediated Rejection in Lung Transplantation

Published on Dec 1, 2015in Current Transplantation Reports
· DOI :10.1007/s40472-015-0074-5
Hrishikesh S. Kulkarni10
Estimated H-index: 10
(WashU: Washington University in St. Louis),
Bradford C. Bemiss1
Estimated H-index: 1
(WashU: Washington University in St. Louis),
Ramsey Hachem28
Estimated H-index: 28
(WashU: Washington University in St. Louis)
There has been increasing awareness of antibody-mediated rejection (AMR) as an important cause of graft failure after lung transplantation in recent years. However, the diagnostic criteria for pulmonary AMR are not well defined. All four tenets of AMR in kidney and heart transplantation, graft dysfunction, complement component deposition, circulating donor-specific antibodies (DSA), and histopathologic changes consistent with AMR are infrequently present in lung transplantation. Nonetheless, the lung transplant community has made important progress recognizing cases of AMR and developing a definition. However, AMR is often refractory to therapy resulting in graft failure and death. In this review, we discuss the progress and challenges in the diagnosis and therapeutic options for pulmonary AMR. In addition, we briefly examine emerging paradigms of C4d-negative AMR and chronic AMR and conclude that significant progress is needed to mitigate the effects of humoral immune responses after lung transplantation.
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