Board Certification Review 2023 Spotlight: Cardiac Transplantation-Rejection: Cellular and Antibody Mediated PDF

Rejection: Cellular and Antibody Mediated PDF

Pdf Summary

This document provides information on the topic of cellular and antibody-mediated rejection in heart transplantation. It includes information on the epidemiology, screening techniques, and management of rejection episodes. <br /><br />The document highlights that about 25% of heart transplant recipients have at least one rejection episode in the first year, with 12-15% receiving treatment for rejection in the same period. Factors such as being a young recipient, African American, female, or allosensitized increase the likelihood of rejection.<br /><br />Endomyocardial biopsy (EMB) is the diagnostic standard for rejection, with different grades indicating the severity of rejection. It can be invasive and subject to interobserver variability. Gene expression profiling (GEP) is a non-invasive technique that can be used to exclude rejection but not confirm its presence.<br /><br />The document also discusses the use of cell-free DNA (cfDNA) as a marker for tissue damage and rejection. Elevated levels of cfDNA are associated with rejection episodes.<br /><br />Treatment options for rejection include corticosteroids, rescue agents, intravenous immunoglobulin (IVIG), plasmapheresis, rituximab, and others. The severity of rejection determines the appropriate treatment approach.<br /><br />The document concludes by mentioning the importance of surveillance for rejection, with endomyocardial biopsy recommended during the first 6-12 months after transplantation. Non-invasive monitoring techniques, such as gene expression profiling, may be used in low-risk patients. The document also provides recommendations for the treatment of asymptomatic and symptomatic rejection, as well as antibody-mediated rejection.<br /><br />Overall, the document provides a comprehensive overview of the topic, including epidemiology, diagnostic techniques, and treatment options for rejection in heart transplantation. It emphasizes the importance of surveillance and tailored treatment approaches based on the severity of rejection episodes.

Keywords

cellular rejection

antibody-mediated rejection

heart transplantation

epidemiology

screening techniques

management of rejection episodes

endomyocardial biopsy

gene expression profiling

cell-free DNA

treatment options