A Comparative Analysis Between Survivors and Nonsurvivors with Antibody Mediated Cardiac Allograft Rejection

Multicenter Analysis of Immune Biomarkers and Heart Transplant Outcomes: Results of the Clinical Trials in Organ Transplantation-05 Study

“…In contrast to findings from previous, predominantly small, single-center biomarker reports of heart transplant recipients (4–20), the results of CTOT-05 did not show significant associations between the majority of the tested biomarkers and the composite endpoint or BPAR. Our findings suggest that the majority of the tested biomarkers are unlikely to be clinically useful surrogates for outcomes.…”

“…With the exception of one multicenter study showing that a peripheral blood gene profile can bypass performing allograft biopsies to detect acute rejection at times >6-months post-transplantation (3), reports of biomarkers in heart transplant recipients have been relatively small, cross-sectional, single center analyses and few have identified predictive biomarkers for CAV at early times post-transplantation (4–20). Several studies have provided evidence that alloreactive T cells detected in peripheral blood (21–26), the quantity of cell-free, donor DNA in recipient’s plasma (27, 28), serum angiogenesis-related factors (29–33), serum anti-HLA antibodies and autoantibodies (34–39) and several peripheral blood gene profiles are associated with acute or chronic heart graft injury (40–43).…”

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

“…Like C4d, C3d persists in tissues longer than C3 and C1q, but because C3d cleavage occurs further downstream in the complement cascade, it indicates progression of complement activation. 35 The combination of C4d and C3d detected by immunofluorescence predicts graft dysfunction and mortality better than C4d alone. 47 Because C3d staining of arterioles may be seen in Immunoglobulin binding and complement activation are regulated in vivo by complement inhibitors.…”

“…[25][26][27][28][29][30][31][32] C4d positivity is also used in combination with histological features-with circulating DSA, or clinical graft dysfunction. 23,[33][34][35][36] Depending on how restrictive the pathological definition of AMR is (ie, number of criteria required), the reported incidence varies, with lower reported incidence with more criteria required. Early estimates using C4d alone ranged from 35% to 71%, whereas those using C4d in combination with other immunopathology markers, clinical graft dysfunction, and DSA reported AMR frequencies of 10%, 27%, and 12.5%, respectively.…”

Clinical outcomes in sensitized heart transplant patients bridged with ventricular assist devices

“…More recent studies have indicated that this difference may not be as significant as previously stated . Other studies have noted a positive correlation between increased sensitization and antibody‐mediated rejection (AMR) episodes . This study sought to evaluate the association between elevated panel‐reactive antibodies (PRAs) and its effects on outcomes, specifically: rejections (both acute cellular and antibody mediated), infections, and mortality.…”