Management Of Antibody Mediated Rejection (Amr) In Heart Transplant Patients: The Real World In A French Single Center Treating All Pathological Amr

Purpose 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. Methods 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. Results 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 5000, 1 patient had persistent graft dysfunction and 80% were alive (Figure1). Conclusion 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.