Figure 2: Proposed management algorithm for AMR in heart transplantation. AMR: antibody-mediated rejection, CNI: calcineurin inhibitors, DSA: donor specific antibodies, IF: immunofluorescence, IH: immunohistochemistry, IVIG: intravenous immunoglobulin, MMF: mycophenolate mofetil, pAMR: ISHLT pathologic AMR grade 0–3, and PSI: proliferation signal inhibitor. *Endomyocardial biopsy frequency as per institution protocol. DSA monitoring at week 2, months 1, 3, 6, and 12 in first year after transplant and annually thereafter. Assessment of allograft function every month and DSA every 3 months until two negative or unchanged results.