Survey of North American pathologist practices regarding antibody-mediated rejection in cardiac transplant biopsies.
BACKGROUND
The 2004 International Society for Heart and Lung Transplantation consensus report specified an entity of histopathologic antibody-mediated rejection (hAMR) but did not define specific histologic criteria. Therefore, there is no gold standard for hAMR diagnosis.


METHODS
In May 2009 we performed a survey of pathologists from cardiac transplant centers in the United States and Canada assessing practices regarding hAMR investigation.


RESULTS
Of 94 centers who responded to our survey (77% response rate), 90% reported investigating for hAMR, and 80% of those reported having a defined protocol. Of centers with a defined protocol, 23% investigated all biopsies for hAMR. Of those who investigated for hAMR selectively, the most common triggers were clinical suspicion (61%) or suggestive histologic findings (36%). Sixteen different stains were used for hAMR investigation, the most common being C4d by immunofluorescence (38%), immunohistochemistry (38%) or both (21%).


CONCLUSIONS
We found wide variation in pathologists' practices regarding hAMR diagnosis. A consensus document regarding hAMR is needed to better align our collective protocols, understand this disease process and to optimize patient care.
Kucirka
Lauren M
LM
Department of Surgery, Division of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Maleszewski
Joseph J
JJ
Segev
Dorry L
DL
Halushka
Marc K
MK
D000906:Antibodies / Q000276:immunology*; D001706:Biopsy / Q000592:standards*; D003167:Complement Activation; D003625:Data Collection; D005455:Fluorescent Antibody Technique / Q000592:standards; D006084:Graft Rejection / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007150:Immunohistochemistry / Q000592:standards; D009206:Myocardium / Q000276:immunology* / Q000473:pathology*; D009656:North America / Q000453:epidemiology; D015588:Observer Variation; D010336:Pathology / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D015995:Prevalence; D011786:Quality Control; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
D000906:Antibodies