PMID- 23953920
OWN - NLM
STAT- MEDLINE
DCOM- 20140529
LR  - 20220331
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Print)
IS  - 1053-2498 (Linking)
VI  - 32
IP  - 10
DP  - 2013 Oct
TI  - Acute antibody-mediated rejection after lung transplantation.
PG  - 1034-40
LID - S1053-2498(13)01344-2 [pii]
LID - 10.1016/j.healun.2013.07.004 [doi]
AB  - BACKGROUND: Antibody-mediated rejection (AMR) after lung transplantation remains 
      enigmatic, and there is no consensus on the characteristic clinical, immunologic 
      and histologic features. METHODS: We performed a retrospective, single-center 
      cohort study and identified cases of acute AMR based on the presence of 
      circulating donor-specific human leukocyte antigen (HLA) antibodies (DSA), 
      histologic evidence of acute lung injury, C4d deposition and clinical allograft 
      dysfunction. RESULTS: We identified 21 recipients with acute AMR based on the 
      aforementioned criteria. AMR occurred a median 258 days after transplantation; 7 
      recipients developed AMR within 45 days of transplantation. All patients had 
      clinical allograft dysfunction, DSA, histology of acute lung injury and capillary 
      endothelial C4d deposition. Fifteen recipients improved clinically and survived 
      to hospital discharge, but 6 died of refractory AMR. One survivor had 
      bronchiolitis obliterans syndrome at the time of AMR diagnosis; 13 of the 14 
      remaining survivors developed chronic lung allograft dysfunction (CLAD) during 
      follow-up. Overall, 15 recipients died during the study period, and the median 
      survival after the diagnosis of AMR was 593 days. CONCLUSIONS: Acute AMR can be a 
      fulminant form of lung rejection, and survivors are at increased risk of 
      developing CLAD. The constellation of acute lung injury, DSA and capillary 
      endothelial C4d deposition is compelling for acute AMR in recipients with 
      allograft dysfunction. This clinicopathologic definition requires validation in a 
      multicenter cohort, but may serve as a foundation for future studies to further 
      characterize AMR.
CI  - (c) 2013 International Society for Heart and Lung Transplantation. All rights 
      reserved.
FAU - Witt, Chad A
AU  - Witt CA
AD  - Division of Pulmonary and Critical Care Medicine, Washington University School of 
      Medicine, St. Louis, Missouri. Electronic address: cwitt@dom.wustl.edu.
FAU - Gaut, Joseph P
AU  - Gaut JP
FAU - Yusen, Roger D
AU  - Yusen RD
FAU - Byers, Derek E
AU  - Byers DE
FAU - Iuppa, Jennifer A
AU  - Iuppa JA
FAU - Bennett Bain, K
AU  - Bennett Bain K
FAU - Alexander Patterson, G
AU  - Alexander Patterson G
FAU - Mohanakumar, Thalachallour
AU  - Mohanakumar T
FAU - Trulock, Elbert P
AU  - Trulock EP
FAU - Hachem, Ramsey R
AU  - Hachem RR
LA  - eng
GR  - R01 HL092514/HL/NHLBI NIH HHS/United States
GR  - R34 HL105412/HL/NHLBI NIH HHS/United States
GR  - HL105412/HL/NHLBI NIH HHS/United States
GR  - HL092514/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20130813
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (Peptide Fragments)
RN  - 80295-50-7 (Complement C4b)
RN  - 80295-52-9 (complement C4d)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antibodies/*immunology/*physiology
MH  - Cohort Studies
MH  - Complement C4b/metabolism
MH  - Female
MH  - Graft Rejection/*epidemiology/*immunology/physiopathology
MH  - HLA Antigens/immunology
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - *Lung Transplantation
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/metabolism
MH  - Pulmonary Disease, Chronic Obstructive/surgery
MH  - Pulmonary Fibrosis/surgery
MH  - Retrospective Studies
MH  - Risk Factors
PMC - PMC3822761
MID - NIHMS515726
OTO - NOTNLM
OT  - C4d deposition
OT  - acute antibody-mediated rejection
OT  - chronic lung allograft dysfunction
OT  - donor specific antibodies
OT  - human leukocyte antigen antibodies
OT  - lung transplantation
EDAT- 2013/08/21 06:00
MHDA- 2014/05/30 06:00
PMCR- 2014/10/01
CRDT- 2013/08/20 06:00
PHST- 2013/04/04 00:00 [received]
PHST- 2013/07/01 00:00 [revised]
PHST- 2013/07/09 00:00 [accepted]
PHST- 2013/08/20 06:00 [entrez]
PHST- 2013/08/21 06:00 [pubmed]
PHST- 2014/05/30 06:00 [medline]
PHST- 2014/10/01 00:00 [pmc-release]
AID - S1053-2498(13)01344-2 [pii]
AID - 10.1016/j.healun.2013.07.004 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2013 Oct;32(10):1034-40. doi: 
      10.1016/j.healun.2013.07.004. Epub 2013 Aug 13.