TY - JOUR
T1 - Antibody-mediated Rejection Without Acute Graft Dysfunction in Adult ABO-compatible Heart Transplantation
T2 - a Case of Accommodation
AU - Angelini, Annalisa
AU - Castellani, Chiara
AU - Poli, Francesca
AU - Benazzi, Elena
AU - Torregrossa, Gianluca
AU - Tona, Francesco
AU - Gambino, Antonio
AU - Caforio, Alida P.
AU - Feltrin, Giuseppe
AU - Toscano, Giuseppe
AU - Valente, Marialuisa
AU - Thiene, Gaetano
AU - Gerosa, Gino
PY - 2008/12
Y1 - 2008/12
N2 - Humoral rejection in heart transplantation is associated with graft dysfunction, circulating anti-donor antibodies and C4d deposits in endomyocardial biopsies. Detecting C4d capillary positivity is of diagnostic and prognostic value. C4d positivity can be found in solid-organ transplants in cases of "accommodation," a form of humoral rejection without graft dysfunction. Accommodation might reflect a change in antibodies or in the antigen, or the graft acquiring a resistance to injury by antibodies and complement. We present a case of accommodation in the setting of adult ABO-compatible orthotopic heart transplantation, which was diagnosed according to the recently introduced ISHLT criteria for humoral rejection: despite this immunologic profile, the patient never showed signs of graft dysfunction. Physicians should be aware of the accommodation phenomenon so they can identify this subset of patients and assess its long-term effects on chronic rejection and outcome in transplanted patients.
AB - Humoral rejection in heart transplantation is associated with graft dysfunction, circulating anti-donor antibodies and C4d deposits in endomyocardial biopsies. Detecting C4d capillary positivity is of diagnostic and prognostic value. C4d positivity can be found in solid-organ transplants in cases of "accommodation," a form of humoral rejection without graft dysfunction. Accommodation might reflect a change in antibodies or in the antigen, or the graft acquiring a resistance to injury by antibodies and complement. We present a case of accommodation in the setting of adult ABO-compatible orthotopic heart transplantation, which was diagnosed according to the recently introduced ISHLT criteria for humoral rejection: despite this immunologic profile, the patient never showed signs of graft dysfunction. Physicians should be aware of the accommodation phenomenon so they can identify this subset of patients and assess its long-term effects on chronic rejection and outcome in transplanted patients.
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U2 - 10.1016/j.healun.2008.09.004
DO - 10.1016/j.healun.2008.09.004
M3 - Article
C2 - 19059119
AN - SCOPUS:57049121235
SN - 1053-2498
VL - 27
SP - 1357
EP - 1360
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 12
ER -