Diagnosis and treatment of antibody mediated rejection in lung transplantation: A retrospective case series

Daoud, Ahmed H. Sulieman; Betensley, Alan D.

doi:10.1016/j.trim.2012.11.009

Cited by 31 publications

(22 citation statements)

References 19 publications

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“…Later studies evaluated IVIG plus rituximab or IVIG plus plasmapheresis plus rituximab. More recently, bortezomib, a proteasome inhibitor, and eculizumab, a monoclonal antibody against terminal complement protein C5 that inhibits terminal complement activation, have been investigated [6]. Daoud et al [6] reported a treatment for AMR.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, bortezomib, a proteasome inhibitor, and eculizumab, a monoclonal antibody against terminal complement protein C5 that inhibits terminal complement activation, have been investigated [6]. Daoud et al [6] reported a treatment for AMR. Two AMR patients after lung transplantation received plasmapheresis and IVIG, resulting in clinical improvement and the ultimate elimination of DSA [6].…”

Section: Discussionmentioning

confidence: 99%

“…Daoud et al [6] reported a treatment for AMR. Two AMR patients after lung transplantation received plasmapheresis and IVIG, resulting in clinical improvement and the ultimate elimination of DSA [6]. …”

Section: Discussionmentioning

confidence: 99%

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A Successful Bilateral Lung Transplantation in a Patient with High Panel Reactive Antibody and Positive Cross Matching

Bok

Jun

Lee

et al. 2014

Korean J Thorac Cardiovasc Surg

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A 44-year-old pregnant female patient gave stillbirth while being treated for pneumonia. She developed acute respiratory failure, which resulted in mechanical ventilator support. Diagnostic lung biopsy revealed a cryptogenic organizing pneumonia. The patient’s condition deteriorated and a venous-venous extracorporeal membrane oxygenation was placed. She was listed for lung transplantation. Because of her worsening condition lung transplantation was performed despite positive cross matching result. She was treated with rituximab, intravenous immunoglobulin, and plasmapheresis and recovered without event. There is no sign of rejection at the time of last follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Successful Bilateral Lung Transplantation in a Patient with High Panel Reactive Antibody and Positive Cross Matching

Bok

Jun

Lee

et al. 2014

Korean J Thorac Cardiovasc Surg

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“…While AMR has been widely recognized in heart and kidney transplantation, it has been enigmatic until recently in lung transplantation because of a smaller sample size and challenges identifying the characteristic histology (6, 7). Nonetheless, there is increasing awareness in the transplant community that antibody-mediated graft injury is an important risk factor for CLAD and a potentially reversible cause of graft failure (8–10). …”

Section: Introductionmentioning

confidence: 99%

Antibody-Mediated Rejection in Lung Transplantation

Kulkarni

Bemiss²,

Hachem

2015

Curr Transpl Rep

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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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“…However, all of these findings are rather nonspecific, and consistency between studies is less than desired. 11,19,20,24 Ideally, DSA positivity correlated with C4d deposition, histologic findings, and clinical status of lung allograft recipients could help in the diagnosis of AMR and ultimately dictate optimal patient care. The goal of this study was to identify lung allograft recipients who developed DSAs and to compare corresponding biopsy specimens for C4d immunofluorescence in order to determine if it is a reliable marker for AMR.…”

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confidence: 99%

The Presence of Anti-HLA Donor-Specific Antibodies in Lung Allograft Recipients Does Not Correlate With C4d Immunofluorescence in Transbronchial Biopsy Specimens

Roberts

Barrios

Cagle

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—C4d immunofluorescence (IF) is a surrogate for development of donor-specific antibodies (DSAs) against human leukocyte antigen (HLA) class I and II antigens in kidney and heart biopsy specimens for monitoring of antibody-mediated (humoral) allograft rejection (AMR). Use of C4d IF in monitoring of lung allografts has shown conflicting results. Objective.—To determine if C4d IF can be used as a reliable marker for AMR and if it correlates with the presence of DSAs and histologic findings on biopsy. Design.—All transbronchial biopsies in lung allograft recipients, performed at our institution in a 3-year period, were reviewed. A cohort of 92 patients with 110 corresponding biopsies met the inclusion criteria of (1) having a resulted DSA within 2 weeks of biopsy and (2) having C4d immunofluorescence studies performed and confirmed. Results.—Twenty-nine patients (31.5%) were positive for DSAs and 63 patients (68.5%) did not develop DSAs. Positive C4d capillary IF was seen in 18 of 110 total biopsy specimens (16.4%). Eight of these biopsy samples were from patients positive for DSAs and 10 were from patients negative for DSAs. The correlation coefficient between the presence of DSAs and C4d IF was 0.1628 (P = .09). Conclusions.—A significant proportion of DSA-positive patients had negative C4d IF results and frequently have no histologic changes on biopsy specimens. DSA-negative patients can be positive for C4d and may show the same histologic changes as reported for DSA-positive patients. Diagnosis of AMR in lung may require a collaborative approach combining clinical data, DSA status, and histology.

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Diagnosis and treatment of antibody mediated rejection in lung transplantation: A retrospective case series

Cited by 31 publications

References 19 publications

A Successful Bilateral Lung Transplantation in a Patient with High Panel Reactive Antibody and Positive Cross Matching

A Successful Bilateral Lung Transplantation in a Patient with High Panel Reactive Antibody and Positive Cross Matching

Antibody-Mediated Rejection in Lung Transplantation

The Presence of Anti-HLA Donor-Specific Antibodies in Lung Allograft Recipients Does Not Correlate With C4d Immunofluorescence in Transbronchial Biopsy Specimens

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