title: Utility of histologic parameters in screening for antibody-mediated rejection of the cardiac allograft: a study of 3,170 biopsies.
abstract: BACKGROUND
  Diagnostic criteria for antibody-mediated rejection (AMR) of the cardiac allograft have recently been proposed as part of the International Society for Heart and Lung Transplantation (ISHLT) biopsy grading scheme. Histologic features of vascular adherence of macrophages (VASC) and endothelial activation or swelling in capillaries (ENDO) are proposed as criteria to prompt the immunohistochemical investigation of biopsies for AMR. The aim of this study was to determine whether VASC and ENDO are adequate to act as screening parameters to trigger further AMR investigation.
  
  
  METHODS
  We examined our database of biopsy findings where histologic vascular parameters as well as immunofluorescence (IF) to detect AMR were collected (n = 3,170). Histologic parameters were graded semi-quantitatively on a scale from 1 to 5, where 1 = absence and 5 = obvious and generalized presence of the finding.
  
  
  RESULTS
  Seven hundred sixty-eight of 3,170 biopsies had IF findings diagnostic of AMR in the absence of cellular rejection (ISHLT = 0). ENDO had a sensitivity of 63% and a specificity of 80%. VASC had a sensitivity of 30% and specificity of 99%. Combining the interpretation of the 2 tests did not result in a significant improvement of test sensitivity.
  
  
  CONCLUSIONS
  Neither ENDO, VASC nor the combination of the tests indicated sufficiently high sensitivity to serve as a screening tool before further diagnostic investigation for AMR. Immunohistochemical testing remains necessary in the majority of cases to identify AMR.
authors.affiliation: Department of Pathology, LDS Hospital, Salt Lake City, Utah 84143, USA. elizabeth.hammond@ihc.com
authors.forename: M Elizabeth H
authors.initials: ME
authors.lastname: Hammond
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.forename: Gregory
authors.initials: G
authors.lastname: Snow
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
authors.forename: James
authors.initials: J
authors.lastname: Seaman
authors.forename: Bashar
authors.initials: B
authors.lastname: Dabbas
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: James C
authors.initials: JC
authors.lastname: Stringham
authors.forename: James W
authors.initials: JW
authors.lastname: Long
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
mesh_terms: D000917:Antibody Formation; D001706:Biopsy; D002196:Capillaries / Q000166:cytology / Q000473:pathology*; D002448:Cell Adhesion; D016208:Databases, Factual; D004730:Endothelium, Vascular / Q000473:pathology; D005455:Fluorescent Antibody Technique; D006084:Graft Rejection / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007150:Immunohistochemistry; D008264:Macrophages; D008403:Mass Screening; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity