title: Report from a consensus conference on antibody-mediated rejection in heart transplantation.
abstract: BACKGROUND
  The problem of AMR remains unsolved because standardized schemes for diagnosis and treatment remains contentious. Therefore, a consensus conference was organized to discuss the current status of antibody-mediated rejection (AMR) in heart transplantation.
  
  
  METHODS
  The conference included 83 participants (transplant cardiologists, surgeons, immunologists and pathologists) representing 67 heart transplant centers from North America, Europe, and Asia who all participated in smaller break-out sessions to discuss the various topics of AMR and attempt to achieve consensus.
  
  
  RESULTS
  A tentative pathology diagnosis of AMR was established, however, the pathologist felt that further discussion was needed prior to a formal recommendation for AMR diagnosis. One of the most important outcomes of this conference was that a clinical definition for AMR (cardiac dysfunction and/or circulating donor-specific antibody) was no longer believed to be required due to recent publications demonstrating that asymptomatic (no cardiac dysfunction) biopsy-proven AMR is associated with subsequent greater mortality and greater development of cardiac allograft vasculopathy. It was also noted that donor-specific antibody is not always detected during AMR episodes as the antibody may be adhered to the donor heart. Finally, recommendations were made for the timing for specific staining of endomyocardial biopsy specimens and the frequency by which circulating antibodies should be assessed. Recommendations for management and future clinical trials were also provided.
  
  
  CONCLUSIONS
  The AMR Consensus Conference brought together clinicians, pathologists and immunologists to further the understanding of AMR. Progress was made toward a pathology AMR grading scale and consensus was accomplished regarding several clinical issues.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Jon
authors.initials: J
authors.lastname: Kobashigawa
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Ensminger
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Annalisa
authors.initials: A
authors.lastname: Angelini
authors.forename: Gerald
authors.initials: G
authors.lastname: Berry
authors.forename: Margaret
authors.initials: M
authors.lastname: Burke
authors.forename: Lawrence
authors.initials: L
authors.lastname: Czer
authors.forename: Nicola
authors.initials: N
authors.lastname: Hiemann
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.forename: Naveen
authors.initials: N
authors.lastname: Pereira
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Platt
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Reed
authors.forename: Nancy
authors.initials: N
authors.lastname: Reinsmoen
authors.forename: E Rene
authors.initials: ER
authors.lastname: Rodriguez
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Rose
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.forename: Randy
authors.initials: R
authors.lastname: Starling
authors.forename: Nicole
authors.initials: N
authors.lastname: Suciu-Foca
authors.forename: Jose
authors.initials: J
authors.lastname: Tallaj
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Adrian
authors.initials: A
authors.lastname: Van Bakel
authors.forename: Lori
authors.initials: L
authors.lastname: West
authors.forename: Adriana
authors.initials: A
authors.lastname: Zeevi
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
mesh_terms: D000906:Antibodies / Q000097:blood; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D016027:Heart Transplantation / Q000276:immunology* / Q000473:pathology; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000906:Antibodies