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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.



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.


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


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%).


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.

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