title: Antibody-mediated rejection: an evolving entity in heart transplantation.
abstract: Antibody-mediated rejection (AMR) is gaining increasing recognition as a major complication after heart transplantation, posing a significant risk for allograft failure, cardiac allograft vasculopathy, and poor survival. AMR results from activation of the humoral immune arm and the production of donor-specific antibodies (DSA) that bind to the cardiac allograft causing myocardial injury predominantly through complement activation. The diagnosis of AMR has evolved from a clinical diagnosis involving allograft dysfunction and the presence of DSA to a primarily pathologic diagnosis based on histopathology and immunopathology. Treatment for AMR is multifaceted, targeting inhibition of the humoral immune system at different levels with emerging agents including proteasome and complement inhibitors showing particular promise. While there have been significant advances in our current understanding of the pathogenesis, diagnosis, and treatment of AMR, further research is required to determine optimal diagnostic tools, therapeutic agents, and timing of treatment.
authors.affiliation: Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada M5G 2C4.
authors.forename: Sharon
authors.initials: S
authors.lastname: Chih
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chruscinski
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.forename: Kathryn
authors.initials: K
authors.lastname: Tinckam
authors.forename: Jagdish
authors.initials: J
authors.lastname: Butany
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao