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antibody-mediated rejection (2)

  • Glen P.Westall, and Greg I.Snell

    The lung transplant community continues to struggle with the diagnosis and management of antibody-mediated rejection. The four diagnostic tenets of donor-specific antibodies, C4d staining, histopathologic changes, and allograft dysfunction, which were largely derived from the early Banff meetings on renal transplantation, have somewhat arbitrarily been applied to lung transplantation. With the passage of time, it is increasingly apparent that merits of these diagnostic pillars are less robust in lung transplantation. In this article, we summarize some of the controversies and challenges surrounding the diagnosis of antibody-mediated rejection in lung transplantation.

    Keywords: Lung transplantation, Antibody-mediated rejection, Humoral rejection, Chronic lung allograft syndrome.…

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  • J.G.O’Leary, A.J.Demetris, L.S.Friedman, H.M.Gebel, P.F.Halloran, A.D.Kirk, S.J.Knechtle, S.V.McDiarmid, A.Shaked, P.I.Terasaki, K.J.Tinckam, S.J.Tomlanovich, K.J.Wood, E.S.Woodle, A.A.Zachary and G.B.Klintmalm

    Several insights emerged. Acute antibody-mediated rejection (AMR), although rarely diagnosed, is increasingly understood to overlap with T cell–mediated rejection. Isolated liver allograft recipients are at increased risk of early allograft immunologic injury when preformed DSA are high titer and persist posttransplantation. Persons who undergo simultaneous liver–kidney transplantation are at risk of renal AMR when Class II DSA persist posttransplantation. Other under-appreciated DSA associations include ductopenia and fibrosis, plasma cell hepatitis, biliary strictures and accelerated fibrosis associated with recurrent liver disease. Standardized DSA testing and diagnostic criteria for both…

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