National Conference to Assess Antibody-Mediated Rejection in Solid Organ Transplantation

TLDR

Humoral rejection is multifaceted, varies across organ types, and has become a leading cause of graft loss, prompting focused attention on antibody‑mediated rejection (AMR) against donor HLA antigens. The conference, held in April 2003, aimed to comprehensively address issues related to humoral rejection. Four workgroups—Profiling, Diagnosis, Treatment, and Basic Science—evaluated detection methods, clinical criteria, desensitization protocols, and immunologic models to guide AMR assessment and intervention. The conference produced a comprehensive expert review and demonstrated that previously insurmountable immunologic barriers can now be consistently overcome, expanding transplant eligibility.

Abstract

The process of humoral rejection is multifaceted and has different manifestations in the various types of organ transplants. Because this process is emerging as a leading cause of graft loss, a conference was held in April 2003 to comprehensively address issues regarding humoral rejection. Though humoral rejection may result from different factors, discussion focused on a paradigm caused by antibodies, typically against donor HLA antigens, leading to the term 'antibody-mediated rejection' (AMR). Conference deliberations were separated into four workgroups: The Profiling Workgroup evaluated strengths and limitations of different methods for detecting HLA reactive antibody, and created risk assessment guidelines for AMR; The Diagnosis Workgroup reviewed clinical, pathologic, and serologic criteria for assessing AMR in renal, heart and lung transplant recipients; The Treatment Workgroup discussed advantages, limitations and possible mechanisms of action for desensitization protocols that may reverse AMR; and The Basic Science Workgroup presented animal and human immunologic models for humoral rejection and proposed potential targets for future intervention. This work represents a comprehensive review with contributions from experts in the fields of Transplantation Surgery, Medicine, Pathology, Histocompatibility, Immunology, and clinical trial design. Immunologic barriers once considered insurmountable are now consistently overcome to enable more patients to undergo organ transplantation.