Cedars-Sinai Heart Institute, Los Angeles, California.
J Heart Lung Transplant. 2011 Mar;30(3):252-69. doi: 10.1016/j.healun.2010.11.003.
The problem of AMR remains unsolved because standardized schemes for diagnosis and treatment remains contentious. Therefore, a consensus conference was organized to discuss the current status of antibody-mediated rejection (AMR) in heart transplantation.
The conference included 83 participants (transplant cardiologists, surgeons, immunologists and pathologists) representing 67 heart transplant centers from North America, Europe, and Asia who all participated in smaller break-out sessions to discuss the various topics of AMR and attempt to achieve consensus.
A tentative pathology diagnosis of AMR was established, however, the pathologist felt that further discussion was needed prior to a formal recommendation for AMR diagnosis. One of the most important outcomes of this conference was that a clinical definition for AMR (cardiac dysfunction and/or circulating donor-specific antibody) was no longer believed to be required due to recent publications demonstrating that asymptomatic (no cardiac dysfunction) biopsy-proven AMR is associated with subsequent greater mortality and greater development of cardiac allograft vasculopathy. It was also noted that donor-specific antibody is not always detected during AMR episodes as the antibody may be adhered to the donor heart. Finally, recommendations were made for the timing for specific staining of endomyocardial biopsy specimens and the frequency by which circulating antibodies should be assessed. Recommendations for management and future clinical trials were also provided.
The AMR Consensus Conference brought together clinicians, pathologists and immunologists to further the understanding of AMR. Progress was made toward a pathology AMR grading scale and consensus was accomplished regarding several clinical issues.
由于诊断和治疗的标准化方案仍存在争议，因此 AMR 问题仍未得到解决。因此，组织了一次共识会议，讨论心脏移植中抗体介导的排斥反应（AMR）的现状。
会议包括 83 名参与者（移植心脏病专家、外科医生、免疫学家和病理学家），代表来自北美、欧洲和亚洲的 67 个心脏移植中心，他们都参加了较小的分组讨论，以讨论 AMR 的各个主题，并尝试达成共识。
建立了 AMR 的暂定病理学诊断，但病理学家认为在正式推荐 AMR 诊断之前需要进一步讨论。此次会议的最重要成果之一是，由于最近的出版物表明无症状（无心脏功能障碍）活检证实的 AMR 与随后更高的死亡率和更严重的心脏同种异体移植血管病发展相关，因此不再需要 AMR 的临床定义（心脏功能障碍和/或循环供体特异性抗体）。还注意到，在 AMR 发作期间并不总是检测到供体特异性抗体，因为抗体可能附着在供体心脏上。最后，还提出了针对心肌活检标本特定染色的时间和循环抗体评估频率的建议。还提出了管理和未来临床试验的建议。
AMR 共识会议汇集了临床医生、病理学家和免疫学家，以进一步了解 AMR。在病理学 AMR 分级量表方面取得了进展，并就几个临床问题达成了共识。
