Antibody-mediated rejection without acute graft dysfunction in adult ABO-compatible heart transplantation: a case of accommodation.
Humoral rejection in heart transplantation is associated with graft dysfunction, circulating anti-donor antibodies and C4d deposits in endomyocardial biopsies. Detecting C4d capillary positivity is of diagnostic and prognostic value. C4d positivity can be found in solid-organ transplants in cases of "accommodation," a form of humoral rejection without graft dysfunction. Accommodation might reflect a change in antibodies or in the antigen, or the graft acquiring a resistance to injury by antibodies and complement. We present a case of accommodation in the setting of adult ABO-compatible orthotopic heart transplantation, which was diagnosed according to the recently introduced ISHLT criteria for humoral rejection: despite this immunologic profile, the patient never showed signs of graft dysfunction. Physicians should be aware of the accommodation phenomenon so they can identify this subset of patients and assess its long-term effects on chronic rejection and outcome in transplanted patients.
Angelini
Annalisa
A
Department of Medical-Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy. annalisa.angelini@unipd.it
Castellani
Chiara
C
Poli
Francesca
F
Benazzi
Elena
E
Torregrossa
Gianluca
G
Tona
Francesco
F
Gambino
Antonio
A
Caforio
Alida P
AP
Feltrin
Giuseppe
G
Toscano
Giuseppe
G
Valente
Marialuisa
M
Thiene
Gaetano
G
Gerosa
Gino
G
D000017:ABO Blood-Group System; D000208:Acute Disease; D001706:Biopsy; D015199:Extracorporeal Membrane Oxygenation; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006680:HLA Antigens / Q000276:immunology; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D006435:Renal Dialysis; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies