Antibody-Mediated Rejection and Lung Transplantation

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Abstract

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.

Original languageEnglish
Pages (from-to)428-435
Number of pages8
JournalSeminars in Respiratory and Critical Care Medicine
Volume42
Issue number3
DOIs
StatePublished - Jun 1 2021

Keywords

  • acute lung injury
  • complement C4d
  • diagnostic techniques and procedures
  • donor-specific antibodies
  • graft rejection
  • lung transplantation
  • outcome assessment

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