TY - JOUR
T1 - Antibody-Mediated Rejection and Lung Transplantation
AU - Halverson, Laura P.
AU - Hachem, Ramsey R.
N1 - Publisher Copyright:
© 2020 American Institute of Physics Inc.. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine, such that there is a significant lack of data regarding the efficacy for these in pulmonary AMR. Lastly, outcomes after AMR remain quite poor despite aggressive treatment. In this review, we revisit the history of AMR in lung transplantation, describe our current understanding of its pathophysiology, discuss the use and limitations of the consensus diagnostic criteria, review current treatment strategies, and summarize long-term outcomes. We conclude with a synopsis of our most pressing gaps in knowledge, introduce recommendations for future directions, and highlight promising areas of active research.
AB - Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine, such that there is a significant lack of data regarding the efficacy for these in pulmonary AMR. Lastly, outcomes after AMR remain quite poor despite aggressive treatment. In this review, we revisit the history of AMR in lung transplantation, describe our current understanding of its pathophysiology, discuss the use and limitations of the consensus diagnostic criteria, review current treatment strategies, and summarize long-term outcomes. We conclude with a synopsis of our most pressing gaps in knowledge, introduce recommendations for future directions, and highlight promising areas of active research.
KW - acute lung injury
KW - complement C4d
KW - diagnostic techniques and procedures
KW - donor-specific antibodies
KW - graft rejection
KW - lung transplantation
KW - outcome assessment
UR - http://www.scopus.com/inward/record.url?scp=85106702454&partnerID=8YFLogxK
U2 - 10.1055/s-0041-1728796
DO - 10.1055/s-0041-1728796
M3 - Article
C2 - 34030204
AN - SCOPUS:85106702454
SN - 1069-3424
VL - 42
SP - 428
EP - 435
JO - Seminars in Respiratory and Critical Care Medicine
JF - Seminars in Respiratory and Critical Care Medicine
IS - 3
ER -