National conference to assess antibody-mediated rejection in solid organ transplantation.
The process of humoral rejection is multifaceted and has different manifestations in the various types of organ transplants. Because this process is emerging as a leading cause of graft loss, a conference was held in April 2003 to comprehensively address issues regarding humoral rejection. Though humoral rejection may result from different factors, discussion focused on a paradigm caused by antibodies, typically against donor HLA antigens, leading to the term 'antibody-mediated rejection' (AMR). Conference deliberations were separated into four workgroups: The Profiling Workgroup evaluated strengths and limitations of different methods for detecting HLA reactive antibody, and created risk assessment guidelines for AMR; The Diagnosis Workgroup reviewed clinical, pathologic, and serologic criteria for assessing AMR in renal, heart and lung transplant recipients; The Treatment Workgroup discussed advantages, limitations and possible mechanisms of action for desensitization protocols that may reverse AMR; and The Basic Science Workgroup presented animal and human immunologic models for humoral rejection and proposed potential targets for future intervention. This work represents a comprehensive review with contributions from experts in the fields of Transplantation Surgery, Medicine, Pathology, Histocompatibility, Immunology, and clinical trial design. Immunologic barriers once considered insurmountable are now consistently overcome to enable more patients to undergo organ transplantation.
Takemoto
Steven K
SK
Dumont Transplant Program & Immunogenetics Center, UCLA School of Medicine, UCLA, Los Angeles, CA, USA. STakemoto@mednet.ucla.edu
Zeevi
Adriana
A
Feng
Sandy
S
Colvin
Robert B
RB
Jordan
Stanley
S
Kobashigawa
Jon
J
Kupiec-Weglinski
Jerzy
J
Matas
Arthur
A
Montgomery
Robert A
RA
Nickerson
Peter
P
Platt
Jeffrey L
JL
Rabb
Hamid
H
Thistlethwaite
Richard
R
Tyan
Dolly
D
Delmonico
Francis L
FL
D000906:Antibodies / Q000737:chemistry*; D001402:B-Lymphocytes / Q000276:immunology; D006084:Graft Rejection; D006680:HLA Antigens / Q000502:physiology; D006650:Histocompatibility Testing; D006801:Humans; D007136:Immunoglobulins / Q000378:metabolism; D016756:Immunoglobulins, Intravenous; D016030:Kidney Transplantation; D016377:Organ Transplantation / Q000379:methods*; D010956:Plasmapheresis; D012306:Risk; D013601:T-Lymphocytes / Q000276:immunology
D000906:Antibodies; D006680:HLA Antigens; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin