title: Antibody-mediated rejection in heart transplant patients: long-term follow up of patients with high levels of donor-directed anti-DQ antibodies.
abstract: Antibody-mediated rejection (AMR) is a complication of orthotopic heart transplantation. There is no standard for treatment and it is unclear what role monitoring of donor-directed antibodies (DSA) should play in guiding treatment decisions. In this case series, we describe three patients transplanted at our center who developed AMR and received rituximab as one component of the treatment regimen. We found in these three patients that despite clinical resolution of AMR, high levels of class II donor-directed antibodies persisted. We also summarize our retrospective analysis of 110 heart allografts that had pre- and post-transplant DSA measurements with corresponding EMB and immunofluorescence (IF) during 2005-2011. Our analysis of a subpopulation of 50 informative patients (with DSA measurements, EMB, and corresponding IF) revealed that moderate and severe cardiac allograft vasculopathy were identified more frequently in grafts with DSA than compared to those without DSA.
authors: Department of Pharmacy, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. erin.ticehurst@uphs.upenn.edu
authors: Erin H
authors: EH
authors: Ticehurst
authors: Maria R
authors: MR
authors: Molina
authors: Renee
authors: R
authors: Frank
authors: Jane
authors: J
authors: Kearns
authors: Priti
authors: P
authors: Lal
authors: Lee R
authors: LR
authors: Goldberg
authors: Donald
authors: D
authors: Tsai
authors: Joyce
authors: J
authors: Wald
authors: Malek
authors: M
authors: Kamoun
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001706:Biopsy; D003324:Coronary Artery Disease / Q000276:immunology; D005455:Fluorescent Antibody Technique; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D006683:HLA-DQ Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology*; D006648:Histocompatibility / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic; D010956:Plasmapheresis; D012189:Retrospective Studies; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006683:HLA-DQ Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab