Contemporary concepts in noncellular rejection.
Acute rejection is the major cause of morbidity and mortality in the first year after cardiac transplantation. Cellular rejection is the most common form of rejection observed; however, noncellular rejection is being seen more often. This noncellular rejection is mostly a result of less well-characterized antibody-mediated mechanisms. Antibody-mediated rejection is associated more commonly with hemodynamic compromise, increased graft loss, cardiac allograft vasculopathy, and increased mortality. Histologic, immunofluorescence, and immunoperoxidase studies of endomyocardial biopsies from such patients often reveal intravascular macrophages and immunoglobulin and complement deposition in capillaries, in the absence of lymphoid infiltrates. Severely ill patients require intense therapy, which includes high-dose corticosteroids, cytolytic agents, intravenous heparin, intravenous gamma globulin, plasmapheresis, and/or antiproliferative agents. Further understanding of noncellular rejection will lead to more effective therapy.
Kobashigawa
Jon A
JA
The David Geffen School of Medicine at UCLA, University of California at Los Angeles Medical Center, Los Angeles, CA 90095, USA. jonk@mednet.ucla.edu
D004730:Endothelium, Vascular / Q000276:immunology / Q000473:pathology; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D016027:Heart Transplantation / Q000276:immunology*; D006353:Heart-Assist Devices; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology
D007166:Immunosuppressive Agents