Antibody-mediated Rejection Without Acute Graft Dysfunction in Adult ABO-compatible Heart Transplantation: a Case of Accommodation

被引：9

作者：

Angelini, Annalisa ^{[1
]}

Castellani, Chiara ^{[1
]}

Poli, Francesca ^{[2
]}

Benazzi, Elena ^{[2
]}

Torregrossa, Gianluca ^{[3
,4
]}

Tona, Francesco ^{[3
,4
]}

Gambino, Antonio ^{[3
,4
]}

Caforio, Alida P. ^{[3
,4
]}

Feltrin, Giuseppe ^{[3
,4
]}

Toscano, Giuseppe ^{[3
,4
]}

Valente, Marialuisa ^{[1
]}

Thiene, Gaetano ^{[1
]}

Gerosa, Gino ^{[3
,4
]}

机构：

[1] Univ Padua, Sch Med, Dept Med Diagnost Sci & Special Therapies, I-35121 Padua, Italy

[2] IRCCS OMP MARE, Dept Regenerat Med Transplant Immunol, Milan, Italy

[3] Univ Padua, Sch Med, Dept Cardiol, Padua, Italy

[4] Univ Padua, Sch Med, Dept Thorac & Vasc Sci, Padua, Italy

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2008年 / 27卷 / 12期

关键词：

D O I：

10.1016/j.healun.2008.09.004

中图分类号：

R5 [内科学];

学科分类号：

1002 [临床医学]; 100201 [内科学];

摘要：

Humoral rejection in heart transplantation is associated with graft dysfunction, circulating anti-donor antibodies and C4d deposits in endomyocardial biopsies. Detecting C4d capillary positivity is of diagnostic and prognostic value. C4d positivity can be found in solid-organ transplants in cases of "accommodation," a form of humoral rejection without graft dysfunction. Accommodation might reflect a change in antibodies or in the antigen, or the graft acquiring a resistance to injury by antibodies and complement. We present a case of accommodation in the setting of adult ABO-compatible orthotopic heart transplantation, which was diagnosed according to the recently introduced ISHLT criteria for humoral rejection: despite this immunologic profile, the patient never showed signs of graft dysfunction. Physicians should be aware of the accommodation phenomenon so they can identify, this subset of patients and assess its long-term effects on chronic rejection and outcome in transplanted patients. J Heart Lung Transplant 2008;27:1357-60. Copyright (C) 2008 by the International Society for Heart and Lung Transplantation.

引用

页码：1357 / 1360

页数：4

共 20 条

[1]

Accommodation of vascularized xenografts: Expression of ''protective genes'' by donor endothelial cells in a host Th2 cytokine environment [J].