Antibody-Mediated Rejection: An Evolving Entity in Heart Transplantation

Figure 2

Proposed management algorithm for AMR in heart transplantation. AMR: antibody-mediated rejection, CNI: calcineurin inhibitors, DSA: donor specific antibodies, IF: immunofluorescence, IH: immunohistochemistry, IVIG: intravenous immunoglobulin, MMF: mycophenolate mofetil, pAMR: ISHLT pathologic AMR grade 0–3, and PSI: proliferation signal inhibitor. *Endomyocardial biopsy frequency as per institution protocol. ^†DSA monitoring at week 2, months 1, 3, 6, and 12 in first year after transplant and annually thereafter. ^‡Assessment of allograft function every month and DSA every 3 months until two negative or unchanged results.