SHINICHI NUNODA    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor (Fixed Term)
Article types	Review article
Language	Japanese
Peer review	Peer reviewed
Presence of invitation	Invited paper
Title	Anti-HLA antibodies and antibody-mediated rejection in heart transplantation
Journal	Formal name：Japanese Journal of Transplantation Abbreviation：移植 ISSN code：05787947/21880034
Domestic / Foregin	Domestic
Volume, Issue, Page	pp.416-422
Authorship	Lead author
Publication date	2016/12
Summary	【Summary】 Early diagnosis and early treatment are important for the antibody-mediated rejection（AMR）to account for 10%―20% of the rejection after heart transplantation because of poor prognosis and the onset extension risk of the cardiac allograft vasculopathy（CAV）. More than 90% of patients have been waitng for heart transplantations with a ventricular assist device for approximately 1,000 days in our country, and anti-HLA antidodies, which cause AMR extension to the next CAV after the transplant, have been paid attention to. The development of the test to detect advances for anti-HLA antibodies in recent years, and there are CDC-XM（complement-dependency-related cytotoxic tests）, AHG-XM, FCXM（flowcyte cross-match）, Solid-phase Assay（ELISA, FCM, Luminex）, make it necessary to know that each characteristic by a target specific antibody, the sensitivity, of the effect of the drug in each to be different. It is recommended that the examination for AMR by the measurement of anti-HLA antibodies and C4dimmunostaining in the posttransplant myocardial biopsy in two and four weeks, and subsequently in 3, 6, 12 months posttransplant, and when clinical AMR is suspected. About AMR caused by the non-HLA antibodies, we soon expect the development of a non-HLA antibody method for measurement. As for the AMR treatment, plasmapheresis, a large amount of intravenous immunoglobulin（IVIG）, antiCD20 monoclonal antibody（rituximab）, use of corticosteroid and/or cyclophosphamide, and switching from cyclosporine to tacrolimus for the immunosuppressive therapy are considered.
DOI	10.11386/jst.51.6_416
Document No.	2017209011