The lung transplant scientific community is working on more precise diagnostic criteria and management protocols. The pathology council of the ISHLT recently proposed a summary statement on the pathology of lung AMR, emphasizing several histological problems due to morphological overlap with other conditions such as infections or other forms of acute lung injury (4). The web-pages cover the main findings used to make the diagnosis of AMR and emblematic cases with clinical/morphological suspicion of AMR. The study was endorsed by the Pulmonary Pathology Working Group (PPWG) of the European Society of Pathology (ESP) and conducted by a
Working Group
of experienced pathologists, supported by clinicians and immunologists.The working group acknowledges the support of Biotest Italia srl through an unrestricted educational grant. Emblematic examples with key learning points were selected and included in the specific web-section
Case Series. The production of this website coincides with the ISHLT working groups recommendations on the definition and diagnostic certainty of clinical pulmonary AMR led by Prof Deborah Levine.
The website represents a comprehensive guide to the problem but is not an exhaustive textbook on the subject. It aims to assist in the knowledge and experience of those working in this field. The website is designed to grow and become a forum for discussion and the exchange of ideas on this subject, and colleagues are invited to submit cases for inclusion following review by the working group.
Martin Goddard (Pathologist, Papworth Hospital, Cambridge, UK - Chair, Pathology Council ISHLT[2015-17])
References : 1. Snyder LD, Wang Z, Chen DF, Reinsmoen NL, Finlen-Copeland CA, Davis WA, Zaas DW, Palmer SM. Implications for human leukocyte antigen antibodies after lung transplantation: a 10-year experience in 441 patients. Chest. 2013 Jul;144(1):226-33.
2. Wu P, Everly MJ, Rebellato LM, Haisch CE, Briley KP, Bolin P, Kendrick WT, Kendrick SA, Morgan C, Harland RC, Terasaki PI. Trends and characteristics in early glomerular filtration rate decline after posttransplantation alloantibody appearance. Transplantation. 2013 Nov 27;96(10):919-25.
3. Tible M, Loupy A, Vernerey D, Suberbielle C, Beuscart T, Cazes A, Guillemain R, Amrein C, Pezzella V, Fabiani JN, Nochy D, Hill G, Empana JP, Jouven X, Charron D, Bruneval P, Duong Van Huyen JP. Pathologic classification of antibody-mediated rejection correlates with donor-specific antibodies and endothelial cell activation. J Heart Lung Transplant. 2013 Aug;32(8):769-76.
4. Berry G, Burke M, Andersen C, Angelini A, Bruneval P, Calabrese F, Fishbein MC, Goddard M, Leone O, Maleszewski J, Marboe C, Miller D, Neil D, Padera R, Rassl D, Revello M, Rice A, Stewart S, Yousem SA. Pathology of pulmonary antibody-mediated rejection: 2012 update from the Pathology Council of the ISHLT. J Heart Lung Transplant. 2013 Jan;32(1):14-21.