PMID- 22890038
OWN - NLM
STAT- MEDLINE
DCOM- 20130426
LR  - 20181201
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 17
IP  - 5
DP  - 2012 Oct
TI  - Antibody-mediated rejection.
PG  - 551-7
LID - 10.1097/MOT.0b013e3283577fef [doi]
AB  - PURPOSE OF REVIEW: The diagnosis of antibody-mediated rejection (AMR) has been 
      revolutionized in recent years by advances in the detection of human leukocyte 
      antigen (HLA) and non-HLA antibodies and by the standardized classification of 
      histologic and immunologic changes in endomyocardial biopsies. The treatment of 
      AMR is also undergoing significant development with targeted use of therapies 
      directed at antibody production and function. RECENT FINDINGS: The diagnosis of 
      AMR achieved greater standardization after a consensus conference in 2010. By the 
      proposed classification, endomyocardial biopsies are now graded on the basis of 
      the severity of histologic and immunologic changes. Management of AMR is often 
      complicated, as patients may have persistent symptoms after treatment, including 
      a reduction in ejection fraction, restrictive physiology leading to recurrent 
      heart failure, and accelerated progression of transplant coronary artery disease. 
      We often rely on therapies to reduce the levels of donor-specific anti-HLA 
      antibodies, including rituximab and bortezomib, as well as photopheresis to alter 
      the function of T cells, although such patients may go on to require redo 
      transplantation. SUMMARY: AMR offers challenges of diagnosis and management, but 
      recent advances in the detection of antibodies, the interpretation of 
      endomyocardial biopsies, and the use of therapies directed toward antibody 
      production offer great promise. In the future, standardization of management 
      across transplant centers will allow for clinical trials of the effectiveness of 
      these therapies.
FAU - Kittleson, Michelle M
AU  - Kittleson MM
AD  - Cedars-Sinai Heart Institute, Los Angeles, California, USA.
FAU - Kobashigawa, Jon A
AU  - Kobashigawa JA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Antibodies/*immunology
MH  - Graft Rejection/drug therapy/*immunology
MH  - HLA Antigens/immunology
MH  - Humans
MH  - Organ Transplantation/*adverse effects/*methods
MH  - *Transplantation Immunology
EDAT- 2012/08/15 06:00
MHDA- 2013/04/27 06:00
CRDT- 2012/08/15 06:00
PHST- 2012/08/15 06:00 [entrez]
PHST- 2012/08/15 06:00 [pubmed]
PHST- 2013/04/27 06:00 [medline]
AID - 10.1097/MOT.0b013e3283577fef [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2012 Oct;17(5):551-7. doi: 
      10.1097/MOT.0b013e3283577fef.