Skip to main content

“Mixed” Rejection in Heart Transplantation

  • Chapter
  • First Online:
The Pathology of Cardiac Transplantation

Abstract

Individually, cellular rejection and antibody-mediated rejection are well characterized and routinely evaluated in cardiac transplant biopsies. The co-occurrence of both of these rejection patterns in the same biopsy, or “mixed rejection,” is also recognized, although not as well documented in the literature. This chapter addresses the question of whether mixed rejection is coincidental or due to cross communication or cross activation between the two arms of the immune system. It also explores potential mechanisms for such an interrelationship, including intermediaries such as innate immune cells, the coagulation system, and endothelial activation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Berry GJ, Burke MM, Andersen C, et al. The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation. J Heart Lung Transplant. 2013;32(12):1147–62.

    Article  PubMed  Google Scholar 

  • Billingham ME, Cary NRB, Hammond ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. J Heart Transplant. 1990;9:587–92.

    CAS  PubMed  Google Scholar 

  • Book WM, Kelley L, Gravanis MB. Fulminant mixed humoral and cellular rejection in a cardiac transplant recipient: a review of the histologic findings and literature. J Heart Lung Transplant. 2003;22(5):604–7.

    Article  PubMed  Google Scholar 

  • Fedrigo M, Feltrin G, Frigo A, Toscano G, Tona F, et al. Mixed acute cellular rejection and antibody mediated rejection in heart transplantation: a retrospective study in a single transplant center. J Heart Lung Transplant. 2014;33(4S):S113.

    Article  Google Scholar 

  • Fedrigo M, Leone O, Burke MM, Rice A, Toquet C, et al. Inflammatory cell burden and phenotype in endomyocardial biopsies with antibody-mediated rejection (AMR): a multicenter pilot study from the AECVP. Am J Transplant. 2015;15(2):526–34.

    Article  CAS  PubMed  Google Scholar 

  • Hammond EH, Yowell RL. Ultrastructural findings in cardiac transplant recipients. Ultrastruct Pathol. 1994;18(1–2):213–20.

    Article  CAS  PubMed  Google Scholar 

  • Hammond EH, Yowell RL, Nunoda S, et al. Vascular (humoral) rejection in heart transplantation: pathologic observations and clinical implications. J Heart Transplant. 1989;8(6):430–43.

    CAS  PubMed  Google Scholar 

  • Hammond EH, Ensley RD, Yowell RL, Craven CM, Bristow MR, Renlund DG, O’Connell JB. Vascular rejection of human cardiac allografts and the role of humoral immunity in chronic allograft rejection. Transplant Proc. 1991;23(2 Suppl 2):26–30.

    CAS  PubMed  Google Scholar 

  • Hammond ME, Stehlik J, Snow G, et al. Utility of histologic parameters in screening for antibody-mediated rejection of the cardiac allograft: a study of 3,170 biopsies. J Heart Lung Transplant. 2005;24(12):2015–21.

    Article  PubMed  Google Scholar 

  • Hidalgo LG, Sis B, Sellares J, Campbell PM, et al. NK cell transcripts and NK cells in kidney biopsies from patients with donor-specific antibodies: evidence for NK cell involvement in antibody-mediated rejection. Am J Transplant. 2010;10(8):1812–22.

    Article  CAS  PubMed  Google Scholar 

  • Johnson DE, Gao SZ, Schroeder JS, DeCampli WM, Billingham ME. The spectrum of coronary artery pathologic findings in human cardiac allografts. J Heart Transplant. 1989;8(5):349–59.

    CAS  PubMed  Google Scholar 

  • Kfoury AG, Hammond ME, Snow GL, et al. Cardiovascular mortality among heart transplant recipients with asymptomatic antibody-mediated or stable mixed cellular and antibody-mediated rejection. J Heart Lung Transplant. 2009;28(8):781–4.

    Article  PubMed  Google Scholar 

  • Labarrere CA, Jaeger BR. Biomarkers of heart transplant rejection: the good, the bad, and the ugly! Transl Res. 2012;159(4):238–51.

    Article  CAS  PubMed  Google Scholar 

  • Lones MA, Czer LS, Trento A, Harasty D, et al. Clinical-pathologic features of humoral rejection in cardiac allografts: a study of 81 consecutive patients. J Heart Lung Transplant. 1995;14(1):151–62.

    CAS  PubMed  Google Scholar 

  • Loupy A, Cazes A, Guillemain R, et al. Very late heart transplant rejection is associated with microvascular injury, complement deposition and progression to cardiac allograft vasculopathy. Am J Transplant. 2011;11(7):1478–87.

    Article  CAS  PubMed  Google Scholar 

  • McAllister Jr HA. Histologic grading of cardiac allograft rejection: a quantitative approach. J Heart Transplant. 1990;9(3 Pt 2):277–82.

    PubMed  Google Scholar 

  • Myles JL, Ratliff NB, McMahon JT, Golding LR, Hobbs RE, et al. Reversibility of myocyte injury in moderate and severe acute rejection in cyclosporine-treated cardiac transplant patients. Arch Pathol Lab Med. 1987;111(10):947–52.

    CAS  PubMed  Google Scholar 

  • Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24(11):1710–20.

    Article  PubMed  Google Scholar 

  • Tan CD, Askar M, Rodriguez ER. Mixed rejection is a Low frequency event and not just cellular rejection and C4d deposition in the cardiac allograft. J Heart Lung Transplant. 2014;33(4S):S113.

    Article  Google Scholar 

  • Tavora F, Munivenkatappa R, Papadimitriou J. Endothelitis in cardiac allograft biopsy specimens: possible relationship to antibody-mediated rejection. J Heart Lung Transplant. 2011;30(4):435–44.

    Article  PubMed  Google Scholar 

  • Taylor DO, Yowell RL, Kfoury AG, et al. Allograft coronary artery disease: clinical correlations with circulating anti-HLA antibodies and the immunohistopathologic pattern of vascular rejection. J Heart Lung Transplant. 2000;19(6):518–21.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dylan V. Miller MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Miller, D.V., Kfoury, A.G. (2016). “Mixed” Rejection in Heart Transplantation. In: Leone, O., Angelini, A., Bruneval, P., Potena, L. (eds) The Pathology of Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-46386-5_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-46386-5_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46384-1

  • Online ISBN: 978-3-319-46386-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics