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Antibody-mediated rejection in heart transplantation

new developments and old uncertainties

Manfredini, Valentinaa; Leone, Ornellab; Agostini, Valentinab; Potena, Lucianoa

Current Opinion in Organ Transplantation: June 2017 - Volume 22 - Issue 3 - p 207–214
doi: 10.1097/MOT.0000000000000407
THORACIC TRANSPLANTATION: Edited by Andreas Zuckermann

Purpose of review Antibody-mediated rejection (AMR) currently represents one of the main problems for clinical management of heart transplant because of its diagnostic complexity and poor evidences supporting treatments.

Recent findings Disorder-based diagnosis is a cornerstone in defining AMR. The limitations of the current classification have been partially overcome by novel studies improving the description of the immune-pathological graft abnormalities, and by new molecular approaches allowing a better understanding of the mechanisms behind AMR and of its relationship with cellular rejection and chronic vasculopathy. In-depth characterization of donor-specific antibodies showed to provide additional prognostic information and guide for treatment. Clinical relevance of AMR is bound to appropriate detection of graft dysfunction. In addition to traditional longitudinal evaluation by echocardiogram, cardiac magnetic resonance and detection of cell-free DNA may represent novel sensitive markers for graft injury that could prompt treatment before dysfunction becomes clinically manifest.

Summary Despite improvements in the diagnostic process, therapeutic strategies made little progress in addition to the consolidation of practices supported by limited evidences. Novel complement inhibitors appear promising in changing this scenario. Nevertheless, collaborative multicenter studies are needed to develop standardized approaches tailored to the highly variable clinical and laboratory features of AMR.

aHeart and Lung Transplant Program

bPathology Department, Bologna University Hospital S.Orsola-Malpighi, Bologna, Italy

Correspondence to Luciano Potena, Azienda Ospedaliero-Universitaria di Bologna, Dipartimento Cardio-Toraco-Vascolare, Padiglione 21, Via Massarenti, 9, 40138 Bologna, Italy. Tel: +39 0512144637; fax: +39 0516363766; e-mail:

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