title: Antibody-mediated rejection in lung transplantation: fable, spin, or fact?
abstract: The lung transplant community continues to struggle with the diagnosis and management of antibody-mediated rejection. The four diagnostic tenets of donor-specific antibodies, C4d staining, histopathologic changes, and allograft dysfunction, which were largely derived from the early Banff meetings on renal transplantation, have somewhat arbitrarily been applied to lung transplantation. With the passage of time, it is increasingly apparent that merits of these diagnostic pillars are less robust in lung transplantation. In this article, we summarize some of the controversies and challenges surrounding the diagnosis of antibody-mediated rejection in lung transplantation.
authors.affiliation: Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia. 1 Address correspondence to: Glen Westall, M.B.B.S., F.R.A.C.P., Ph.D., Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Vic, Australia, 3181.
authors.forename: Glen P
authors.initials: GP
authors.lastname: Westall
authors.forename: Greg I
authors.initials: GI
authors.lastname: Snell
mesh_terms: D064591:Allografts; D000906:Antibodies / Q000276:immunology*; D015415:Biomarkers / Q000378:metabolism; D015935:Complement C4b / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D016030:Kidney Transplantation; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation / Q000009:adverse effects*; D010446:Peptide Fragments / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D015415:Biomarkers; D006680:HLA Antigens; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d