title: Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation.
abstract: Antibody-mediated rejection (AMR) is a recognized cause of allograft dysfunction in lung transplant recipients. Unlike AMR in other solid-organ transplant recipients, there are no standardized diagnostic criteria or an agreed-upon definition. Hence, a working group was created by the International Society for Heart and Lung Transplantation with the aim of determining criteria for pulmonary AMR and establishing a definition. Diagnostic criteria and a working consensus definition were established. Key diagnostic criteria include the presence of antibodies directed toward donor human leukocyte antigens and characteristic lung histology with or without evidence of complement 4d within the graft. Exclusion of other causes of allograft dysfunction increases confidence in the diagnosis but is not essential. Pulmonary AMR may be clinical (allograft dysfunction which can be asymptomatic) or sub-clinical (normal allograft function). This consensus definition will have clinical, therapeutic and research implications.
authors.affiliation: Pulmonary Disease and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Levine
authors.affiliation: The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia. Electronic address: allan.glanville@svha.org.au.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
authors.affiliation: The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Aboyoun
authors.affiliation: Pulmonary Disease and Critical Care Medicine, University of California, Los Angeles, California, USA.
authors.forename: John
authors.initials: J
authors.lastname: Belperio
authors.affiliation: Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.affiliation: Division of Pathology, Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Berry
authors.affiliation: Division of Pulmonology, Washington University, St. Louis, Missouri, USA.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Hachem
authors.affiliation: Department of Pulmonology, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Desley
authors.initials: D
authors.lastname: Neil
authors.affiliation: Department of Immunology, Cedars-Sinai Hospital, Los Angeles, California, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Reinsmoen
authors.affiliation: Department of Pulmonology, Duke University, Durham, North Carolina, USA.
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.affiliation: Division of Pulmonology, Washington University, St. Louis, Missouri, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sweet
authors.affiliation: Division of Pathology, Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Dolly
authors.initials: D
authors.lastname: Tyan
authors.affiliation: Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Verleden
authors.affiliation: Department of Pulmonology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Glen
authors.initials: G
authors.lastname: Westall
authors.affiliation: Division of Pulmonology, Washington University, St. Louis, Missouri, USA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Department of Pulmonology, University of Colorado, Denver, Colorado, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Zamora
authors.affiliation: Department of Immunology, University of Pittsburgh, Pittsburgh, Pennyslvania, USA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Zeevi
mesh_terms: D006084:Graft Rejection / Q000276:immunology*; D016027:Heart Transplantation; D006801:Humans; D007391:International Cooperation; D007518:Isoantibodies / Q000276:immunology; D016040:Lung Transplantation; D012955:Societies, Medical; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D007518:Isoantibodies
keywords: HLA antibodies; allograft dysfunction; lung transplantation; rejection