The Importance of Non-HLA Antibodies After Heart Transplant
AbstractPurpose of ReviewAntibodies to human leukocyte antigens (HLA) are associated with adverse patient and allograft outcomes after heart transplantation. Non-HLA antibodies have increasingly been recognized as important mediators of rejection, cardiac allograft vasculopathy (CAV), and allograft injury. In particular, these antibodies have been implicated in a subset of heart transplant recipients who have clinical and/or pathologic evidence of antibody-mediated rejection in the absence of detectable antibodies against HLA.Recent FindingsNon-HLA antigens have been identified to have important roles in both the innate and adaptive immune response in transplantation. These antigens are predominantly expressed on vascular endothelium of the donor heart and include major histocompatibility class I related chain A (MICA), G protein coupled receptor angiotensin II type 1 receptor (AT1R), cytoskeletal elements such as myosin and vimentin. A growing number of studies have demonstrated antibodies to these antigens in rejection and development of CAV. At present, non-HLA antibodies are not routinely monitored post-transplant, and laboratory evaluation remains non-standardized. Further investigation is required to improve the detection of non-HLA antibodies, define pathophysiological mechanisms involved in allograft injury, and better understand their impact on clinical outcomes.SummaryNon-HLA antibodies have been identified as important mediators of rejection, allograft dysfunction,...
This study aimed to define the ultrastructural changes of the endothelium in lung allografts in the setting of AMR and determine its specificity for AMR.
ConclusionsHEARTBiT’s diagnostic performance compares favourably to the only currently approved, minimally-invasive diagnostic test to rule out ACR, AlloMap, and may be used to inform care decisions in the first 2 months post-transplantation, when AlloMap is not approved, and most ACR episodes occur.
Molecular biology has emerged as a potential companion to histology for the diagnosis of rejection after heart transplantation. Reverse transcriptase multiplex ligation-dependent probe amplification (RT-MLPA) is a technique of targeted gene expression analysis suitable for formalin-fixed paraffin-embedded (FFPE) biopsies. Our aim was to assess RT-MLPA for the diagnosis of allograft rejection in heart transplantation.
Restrictive allograft syndrome (RAS) after lung transplantation (LTx) is associated with the poorer graft survival in patients with chronic lung allograft dysfunction (CLAD). Nevertheless, its diagnostic criteria remain not well defined after single-LTx (SLTx). Hence, we studied an SLTx cohort with CLAD to investigate the utility of both CT-score/volume measures and functional spirometric criteria for early identifying RAS in this population.
ConclusionThis animal study demonstrates the feasibility of using this novel technique for resuscitation and precardiectomy evaluation of donated after circulatory death hearts. For those donor hearts without adequate function, an LVAD can be safely implanted as a “bail‐out” option. The limitations of this technique are the patient population to which it can be applied (only those patients eligible and consented for LVAD).
This study aimed to summarize and analyze the data of LT development in China. METHODS: We retrospectively collected and analyzed data from the China Lung Transplantation Registry (CLuTR). Key data were reported from the registry with transplant types, indications, donor and recipient characteristics, outcomes and survival. The survival
Acute rejection is one of the most important direct contributors of mortality after heart transplantation. Advances in the development of novel non-invasive approaches for the early identification of allograft rejection are necessary. We conducted a non-targeted proteome characterization focused on identifying multiple plasmatic protein differences to evaluate their diagnostic accuracy for rejection episodes.
The objective of this study was to determine the association between azithromycin use, CLAD, acute rejection, airway inflammation, and bacterial microbiota composition and structure after LTx.
The objective of this study was to determine the association between azithromycin use, CLAD, acute rejection, airway inflammation and bacterial microbiota composition and structure after LTx.
Sustained, indolent immune injury of the vasculature of a heart transplant limits long-term graft and recipient survival. This injury is mitigated by a poorly characterized, maladaptive repair response. Vascular endothelial cells respond to proangiogenic cues in the embryo by differentiation to specialized phenotypes, associated with expression of apelin. In the adult, the role of developmental proangiogenic cues in repair of the established vasculature is largely unknown. We found that human and minor histocompatibility–mismatched donor mouse heart allografts with alloimmune-mediated vasculopathy upregulated express...