Pathology of pulmonary antibody-mediated rejection: 2012 update from the Pathology Council of the ISHLT

Antibody-Mediated Rejection in Lung Transplantation: Clinical Outcomes and Donor-Specific Antibody Characteristics

“…Analysis of specificities and immunodominant MFI demonstrated that DSAs from DSA pos AMR pos patients had characteristics distinct from those of DSA pos AMR neg patients. These results provide evidence that bolsters the clinical relevance of the previously proposed AMR definitions in LT (19,20).…”

“…The presence of DSAs, clinical dysfunction or histological pattern suggestive of AMR was further characterized by C4d immunohistochemical stains performed on formalin-fixed, paraffin-embedded tissue sections. Biopsy staining was considered positive if C4d was found to be deposited along capillary walls; subsequent distribution was characterized as focal (<50%) or diffuse (!50%), and an intensity score was ascribed (from 1 to 3) (19).…”

“…This was followed by multiple informative clinical (13)(14)(15)(16) and pathologic (17,18) reports that sketched the boundaries of AMR in LT. According to the most recent International Society for Heart and Lung Transplantation (ISHLT) update (19), the diagnosis of pulmonary AMR requires a multidisciplinary approach that includes the presence of clinical allograft dysfunction, circulating DSAs, and explicit pathologic findings. Because of lack of specificity and technical difficulties, not only is C4d staining cautiously interpreted, its inclusion in AMR diagnosis remains a matter of debate (20).…”

Models of Lung Transplant Research: a consensus statement from the National Heart, Lung, and Blood Institute workshop

“…Both A and B types of ACR are thought to increase the risk of development of bronchiolitis obliterans syndrome (BOS). The other form of AR, AMR, is not as well characterized but has been described as including C4d deposition in capillaries, neutrophilic capillaritis, intravascular macrophages, and acute lung injury (55,56). Preclinical models have been useful for exploring mechanisms of both ACR and AMR (summarized in Table 2).…”

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

“…15 These findings were not included in agreement studies but were reported for any case in which either or all reviewers raised the possibility of chronic vascular rejection. Antibody-mediated rejection was assessed according to the 2012 update from the Pathology Council of the ISHLT 17 and as previously summarized. 16 Any additional histopathologic findings were recorded.…”