303: Hemodynamic Compromise Rejection: Does the Heart Biopsy Influence Outcome?

Complement Fragment C4d and C3d Deposition in Pediatric Heart Receipients With a Positive Crossmatch

“…We observed many episodes of reversible left ventricular dysfunction after treatment of rejection associated with low grades (0 or 1R) of ISHLT rejection that were consistent with a diagnosis of antibody-mediated rejection, 1,8 but not associated with capillary deposition of C4d or pericapillary macrophage infiltration. The presence of graft dysfunction in the absence of histologic findings of cellular or antibody-mediated rejection that is reversible with anti-rejection therapy has been described elsewhere 23 and suggested that non-complement-activating antibodies may play a role in antibody-mediated rejection in humans, as has been described in experimental cardiac transplant models. 24 It has previously been emphasized that complement deposition in an endomyocardial biopsy specimen per se is not diagnostic of antibody-mediated rejection.…”