Abstract
<h3>Purpose</h3> There is no consensus for the treatment of antibody mediated rejection (AMR) in heart transplant patients (HTP), only expert recommendation with a grey zone in patients without graft dysfunction. The purpose of the study was to report our AMR management since we perform routine screening of donor-specific antibodies (DSA) with EMB in case of positive DSA and treat AMR irrespective of graft dysfunction, severity of AMR or presence of DSA. <h3>Methods</h3> We retrospectively reviewed HTP between 2011 and 2019 and studied patients with AMR defined only on endomyocardial biopsy (EMB) according to the latest ISHLT criteria. <h3>Results</h3> A total of 15 patients developed AMR (5 patients with pAMR 1 and 10 with pAMR2) (Figure1), followed for a mean of 4.6 years; 3 patients (20%) had a graft dysfunction (EF<40%) and 3 (20%) did not have circulating DSA. All patients received intravenous steroids, plasmapheresis (5 to7 sessions only for DSA+ patients) IVig for 2 days and rituximab. The 7 more recent patients had additional IVig therapy (high-dose regimen) for 6 weeks and 5 patients received bortezomib. At the end of the treatment, 12 patients (60%) had normal EMB, 6 patients (50%) had persistent DSA with MFI>5000, 1 patient had persistent graft dysfunction and 80% were alive (Figure1). <h3>Conclusion</h3> despite a short follow up, our experience is encouraging to treat aggressively all pathological AMR irrespective of graft dysfunction or presence of DSA to prevent graft dysfunction and poor outcomes.
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