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Semin Respir Crit Care Med 2021; 42(03): 428-435
DOI: 10.1055/s-0041-1728796
Review Article

Antibody-Mediated Rejection and Lung Transplantation

Laura P. Halverson
1   Division of Pulmonary and Critical Care, Washington University School of Medicine, Saint Louis, Missouri
,
Ramsey R. Hachem
1   Division of Pulmonary and Critical Care, Washington University School of Medicine, Saint Louis, Missouri
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Abstract

Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine, such that there is a significant lack of data regarding the efficacy for these in pulmonary AMR. Lastly, outcomes after AMR remain quite poor despite aggressive treatment. In this review, we revisit the history of AMR in lung transplantation, describe our current understanding of its pathophysiology, discuss the use and limitations of the consensus diagnostic criteria, review current treatment strategies, and summarize long-term outcomes. We conclude with a synopsis of our most pressing gaps in knowledge, introduce recommendations for future directions, and highlight promising areas of active research.

Keywords

lung transplantation - graft rejection - acute lung injury - complement C4d - donor-specific antibodies - diagnostic techniques and procedures - outcome assessment


Publication History

Article published online:
24 May 2021

© 2021. Thieme. All rights reserved.

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