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Is Pathologic AMR Grading Scale Associated with the Presence of Donor-Specific Antibodies?

S. Kim, J. Patel, M. Kittleson, T. Singer-Englar, N. Patel, D. Chang, E. Kransdorf, D. Emerson, J. A. Kobashigawa

Cedars-Sinai Smidt Heart Institute, Los Angeles, CA

Meeting: 2022 American Transplant Congress

Abstract number: 1131

Keywords: Antibodies, Rejection

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Antibody-mediated rejection (AMR) has been defined by an expert pathology group in 2011 which resulted in the ISHLT pathologic AMR (pAMR) grading scale. The presence of donor-specific antibodies (DSA) were not included as these were reported not to have a high association with this grading scale. However, in the current era of newer immunosuppression and better antibody detection techniques, it is not clear if this is still the case. Therefore, we sought to assess the presence of DSA by single antigen via the Luminex platform in the current era of 2015 to 2020.

*Methods: Between November 2015 and November 2020, we assessed 39 heart transplant patients and assessed the patients who had first year pAMR1, pAMR2, or pAMR3. The entire group was assessed for the presence of DSA 1 to 2 weeks before or after the biopsy was performed.

*Results: DSA was present in 35.7% of the patients with pAMR1 and in 84.0% of the patients with pAMR2. There was no significant difference between the two groups in the mean ejection fraction at the time of biopsy and mean maximum mean fluorescence intensity (MFI) of DSA found in patients. Of note, the mean maximum MFIs were in the strong binding range. There were no patients with pAMR3.

*Conclusions: Presence of DSA appears to be more associated with pAMR2 and less with pAMR1. This data underscores the antibody involvement of pAMR2. Larger studies to assess clinical outcome will be paramount.

pAMR1 (n=14) pAMR2 (n=25) P-Value
Ejection fraction at time of biopsy, mean % ± SD 62 ± 13 62 ± 7 0.872
Incidence of DSA (single antigen) 35.7% 84.0% 0.002
Maximum MFI, mean ± SD 12000 ± 7544 10773 ± 5610 0.684
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To cite this abstract in AMA style:

Kim S, Patel J, Kittleson M, Singer-Englar T, Patel N, Chang D, Kransdorf E, Emerson D, Kobashigawa JA. Is Pathologic AMR Grading Scale Associated with the Presence of Donor-Specific Antibodies? [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/is-pathologic-amr-grading-scale-associated-with-the-presence-of-donor-specific-antibodies/. Accessed May 9, 2025.

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