Immediate and long-term impact of anti-graft antibodies in cardiac allografts

Heart transplantation has become an important therapeutic option for the treatment of end-stage heart disease. Over the past 40 years, much has been learned about the immunologic responses to the allograft heart, including elucidation of the mechanisms of acute cellular rejection and antibody-mediated rejection (AMR). In AMR, damage to the allograft vasculature including capillaries and coronary arteries causes graft dysfunction and decreased survival. The recent recognition of AMR in cardiac transplantation has led to an evolution in the evaluation of the biopsy and graft surveillance. The use of serologic testing and both histologic and immunohistochemical criteria have improved the detection of AMR.