Intermountain Heart Institute and Intermountain Healthcare, University of Utah School of Medicine, and Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, Salt Lake City, Utah, USA.
Curr Opin Organ Transplant. 2019 Jun;24(3):259-264. doi: 10.1097/MOT.0000000000000640.
Defining criteria for antibody-mediated rejection (AMR) in heart transplantation were standardized a few years ago, but very little is known about asymptomatic cardiac AMR. We will start the review with a background summarizing the timeline of cardiac AMR. Then we will cover past and current knowledge about asymptomatic cardiac AMR and its impact on outcome after transplantation, with added insight from experience with other solid-organ transplants.
The incidence of asymptomatic cardiac AMR had likely been under-estimated because biopsy surveillance for it in the absence of clinical manifestation was not the norm. Recent data indicate that it may be more common especially when counting concomitant acute cellular rejection (mixed rejection). Also a higher risk of cardiac allograft vasculopathy (CAV) and cardiovascular mortality have been linked to it. The primary implication of these findings is whether therapeutic intervention is warranted, but the appropriate target patient population likely to benefit from treatment is yet to be determined.
Asymptomatic cardiac AMR is not uncommon and it negatively impacts outcome after heart transplantation.
几年前，心脏移植中抗体介导排斥反应（AMR）的定义标准已得到规范，但对无症状性心脏 AMR 知之甚少。我们将从概述心脏 AMR 时间线的背景开始综述。然后，我们将介绍无症状性心脏 AMR 及其对移植后结局的影响的既往和现有知识，并从其他实体器官移植的经验中获得新的见解。
由于缺乏临床表现的情况下没有进行活检监测，无症状性心脏 AMR 的发生率可能被低估了。最近的数据表明，它可能更为常见，尤其是在同时伴有急性细胞排斥反应（混合排斥反应）时。此外，它与心脏移植物血管病（CAV）和心血管死亡率升高有关。这些发现的主要意义在于是否需要进行治疗干预，但尚不确定哪些患者人群可能从治疗中获益。
无症状性心脏 AMR 并不少见，它会对心脏移植后的结局产生负面影响。
