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Cardiovasc Pathol. 2011 May-Jun;20(3):132-8. doi: 10.1016/j.carpath.2010.03.008. Epub 2010 Apr 24.

Survey of North American pathologist practices regarding antibody-mediated rejection in cardiac transplant biopsies.

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  • 1Department of Surgery, Division of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

BACKGROUND:

The 2004 International Society for Heart and Lung Transplantation consensus report specified an entity of histopathologic antibody-mediated rejection (hAMR) but did not define specific histologic criteria. Therefore, there is no gold standard for hAMR diagnosis.

METHODS:

In May 2009 we performed a survey of pathologists from cardiac transplant centers in the United States and Canada assessing practices regarding hAMR investigation.

RESULTS:

Of 94 centers who responded to our survey (77% response rate), 90% reported investigating for hAMR, and 80% of those reported having a defined protocol. Of centers with a defined protocol, 23% investigated all biopsies for hAMR. Of those who investigated for hAMR selectively, the most common triggers were clinical suspicion (61%) or suggestive histologic findings (36%). Sixteen different stains were used for hAMR investigation, the most common being C4d by immunofluorescence (38%), immunohistochemistry (38%) or both (21%).

CONCLUSIONS:

We found wide variation in pathologists' practices regarding hAMR diagnosis. A consensus document regarding hAMR is needed to better align our collective protocols, understand this disease process and to optimize patient care.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID:
20418115
[PubMed - indexed for MEDLINE]
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