Table of Contents Author Guidelines Submit a Manuscript
Journal of Transplantation
Volume 2012, Article ID 210210, 10 pages
http://dx.doi.org/10.1155/2012/210210
Review Article

Antibody-Mediated Rejection: An Evolving Entity in Heart Transplantation

1Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada M5G 2C4
2Multi-Organ Transplant, University Health Network, Toronto General Hospital, Toronto, ON, Canada M5G 2N2
3Histocompatibility Laboratory, University Health Network, Toronto General Hospital, Toronto, ON, Canada M5G 2M1
4Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada M5G 2C4
5Division of Cardiac Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada M5G 2C4

Received 15 October 2011; Revised 19 December 2011; Accepted 21 December 2011

Academic Editor: Mark Haas

Copyright © 2012 Sharon Chih et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.