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中华移植杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 266 -276. doi: 10.3877/cma.j.issn.1674-3903.2022.05.002


  1. 1. 200032 复旦大学附属中山医院心脏外科 上海市心血管病研究所 上海市器官移植重点实验室
  • 收稿日期:2022-06-23 出版日期:2022-10-25
  • 通信作者: 杨守国

Current status and progress on antibody-mediated rejection in heart transplantation

Shouguo Yang1,()   

  1. 1. Department of Cardiac Surgery, Zhongshan Hospital, Fudan University; the Shanghai Institute of Cardiovascular Diseases; the Key Lab of Shanghai Organ Transplantation, Shanghai 200032, China
  • Received:2022-06-23 Published:2022-10-25
  • Corresponding author: Shouguo Yang

杨守国. 心脏移植术后抗体介导排斥反应研究现况与进展[J]. 中华移植杂志(电子版), 2022, 16(05): 266-276.

Shouguo Yang. Current status and progress on antibody-mediated rejection in heart transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2022, 16(05): 266-276.


Antibody-mediated rejection (AMR) is proved to be a crucial complication in heart transplantation, which has not been well evaluated and studied in China. Nowadays, it is considered that AMR contains a series of evolution process from pathological changes to clinic manifestation, which starts with the accumulation of immune factors (such as antibody, complement), the activation of complement and ends with graft tissues injury. Clinically, AMR was classified as circulating antibody silent stage, sub-clinical stage and symptomatic AMR stage. The mechanism of AMR involved in an inflammatory reaction induced by deposition of immunoglobulins and complements within the microvessels of the grafts, in which the activation of complements played a core role. Therefore, immunological assay of C4d and C3d in endomyocardial biopsy specimens combined with evidence of histopathology capillaries injury were necessary for the diagnosis of AMR. While noninvasive gene detection with Allomap and donor-derived cell-free DNA were effective method serving as screening and monitoring AMR. Recommendations on management of AMR consisted a combination of corticosteroid, intravenous immune globulin, plasmapheresis or rituximab by scale of AMR, which were proven to be effective against immune injury. However, the efficacy of anti-CD52 monoclonal antibody, eculizumab and photochemotherapy remains to be further evaluated.

表1 ISHLT不同时期AMR病理诊断及分级标准[6]
图1 心脏移植术后AMR组织病理学改变[6]注:AMR.抗体介导排斥反应;a.组织病理学可见毛细血管内皮细胞肿胀,血管内巨噬细胞聚集(HE染色); b.免疫过氧化物酶染色可见血管内CD68染色阳性细胞
表2 AMR的免疫组分与意义
图2 毛细血管C4d和C3d免疫荧光染色(FITC×60)[13]
表3 ISHLT 2013版心脏移植AMR诊断依据[2]
表4 ISHLT 2013版推荐的AMR病理分级标准[2]
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