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PATHOLOGIC DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION (AMR)

PATHOLOGIC DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION (AMR). Histopathologic findings. Immunopathologic findings. Immunohistochemistry on paraffin sections. Immunofluorescence o n frozen tissue. HISTOPATHOLOGIC FEATURES. IMMUNOHISTOCHEMISTRY ON PARAFFIN SECTIONS. ANTIBODY PANELS

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PATHOLOGIC DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION (AMR)

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  1. PATHOLOGIC DIAGNOSIS OF ANTIBODY-MEDIATED REJECTION (AMR) Histopathologic findings Immunopathologic findings Immunohistochemistry on paraffinsections Immunofluorescence on frozentissue

  2. HISTOPATHOLOGIC FEATURES

  3. IMMUNOHISTOCHEMISTRY ON PARAFFIN SECTIONS

  4. ANTIBODY PANELS FOR PARAFFIN IMMUNOHISTOCHEMISTRY

  5. Evaluation criteria of C4d staining on paraffinsection

  6. Evaluation criteria of CD68 staining

  7. Criteria for immunopathological diagnosis of AMR

  8. IMMUNOFLUORESCENCE ON FROZEN TISSUE

  9. ANTIBODY PANELS FOR IMMUNOFLUORESCENCE

  10. Evaluation criteria of C4d / C3d staining on frozensections

  11. Criteria for immunopathological diagnosis of AMR on frozen sections

  12. The 2012 ISHLT Working Formulation grading for biopsy diagnosis of pathological AMR (pAMR)

  13. INDICATIONS FOR IMMUNOPATHOLOGICAL TESTS • Histopathologicalfindings • Clinicalevidence of graftdysfunction in absence of ACR or other cause • Serology: pre-transplant or de novo donorspecificantibodies(DSAs) • In the case of a positive endomyocardialbiopsy (EMB), immunostaining of subsequentbiopsiesshould be continueduntil C4d is negative. • When a patienthasbeentreated for AMR, a repeat EMB should be takennotlessthan 2 weeks later. • EMB SURVEILLANCE FOR AMR • Eachbiopsy must be fullyevaluated for AMR at: • 2 and 4 weeks aftertransplantation • 3, 6, 12 monthsaftertransplantation • subsequently: annually

  14. MIXED REJECTION • Histological picture including diagnostic criteria for both cellular rejection (ACR) and antibody-mediated rejection (AMR). • ACR must be evaluated according to 2005 with/without 1990 ISHLT-WF (according to individual centres’ routine) • AMR is separately evaluated according to the 2013 ISHLT-WF

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