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Publications

Journal Article Practice Guideline Ahead of print

PubMed: 42274447 DOI: 10.1016/j.healun.2026.04.019

International Society for Heart and Lung Transplantation Scientific Statement on pulmonary antibody-mediated rejection and proposed graft, antibody, and pathology (GAP) definition.

J Heart Lung Transplant

Authors: Fiorella Calabrese, Deborah J Levine, Benjamin A Adam, Sean Agbor-Enoh, Christian Benden, Marie M Budev, Adam B Cochrane, Emanuele Cozzi, David R Darley, Gregory A Fishbein, Andrew E Gelman, Allan R Glanville, John R Greenland, Michelle J Hickey, Fabio Ius, Peter Jaksch, Annette M Jackson, John O Joerns, Hong Lor, Erin M Lowery, Massimo Mangiola, Letizia Corinna Morlacchi, Michelle A Murray, Arun Nair, Honoria Ocagli, Jasvir S Parmar, Elizabeth N Pavlisko, Michael Perch, Franck F Rahaghi, Anja C Roden, Antoine Roux, Laurie Snyder, Stuart Sweet, Stijn E Verleden, Gary A Visner, Robin Vos, Kathryn A Wikenheiser-Brokamp, Adriana Zeevi, Ramsey R Hachem

Affiliations

  • University of Padova Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Italy.
  • Stanford Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford, California.
  • University of Alberta, Department of Laboratory Medicine and Pathology, Canada.
  • National Heart, Lung, and Blood Institute, Division of Intramural Research and Johns Hopkins School of Medicine, Department of Medicine, Bethesda, Maryland.
  • University of Zurich, Switzerland; Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  • The Cleveland Clinic, Cleveland, Ohio.
  • Inova Fairfax Medical Center, Falls Church, Virginia.
  • Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
  • David Geffen School of Medicine at UCLA, Los Angeles, California.
  • Washington University School of Medicine, Department of Surgery, St. Louis, Missouri.
  • University of California San Francisco and San Francisco VA Health Care System, San Francisco, California.
  • Hannover Medical School, Department of Cardiothoracic Surgery, Hanover, Germany.
  • Medical University of Vienna, Department of Thoracic Surgery, Vienna, Austria.
  • Duke University, Department of Surgery, Durham, North Carolina.
  • Mayo Clinic College of Medicine, Rochester, Minnesota.
  • Liverpool Hospital Pharmacy, Liverpool, Australia.
  • University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
  • NYU Grossman School of Medicine, NYU Langone Health, Transplant Institute, New York, New York.
  • Universita degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Milan, Italy.
  • National Lung Transplant Unit, Mater Hospital, University College Dublin, Dublin, Ireland.
  • Freeman Hospital Institute of Transplantation, NHS Foundation Trust and Newcastle University, Tyne, England.
  • Royal Papworth Hospital, NHS Foundation Trust, Cambridge, England.
  • Duke University Medical Center, Department of Pathology, Durham, North Carolina.
  • University of Copenhagen, Department of Cardiology, Section of Lung Transplantation, Copenhagen, Denmark.
  • Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida.
  • Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
  • Hopital Foch, Pneumology, Adult Cystic Fibrosis Center and Lung Transplantation Department.
  • Duke University Medical Center, Department of Medicine, Durham, North Carolina.
  • Washington University in St. Louis, Department of Pediatrics, St. Louis, Missouri.
  • University of Antwerp, Antwerp Surgical Training Anatomy and Research Centre, Antwerp, Belgium.
  • Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  • University Hospitals Leuven, Department of Respiratory Diseases, Leuven, Belgium.
  • University of Cincinnati, Department of Pathology and Laboratory Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Divisions of Pathology and Laboratory Medicine and The Perinatal Institute Division of Pulmonary Biology, Department of Pathology and Laboratory Medicine, Cincinnati, Ohio.
  • University of Pittsburgh, Department of Pathology, Pittsburgh, Pennsylvania.
  • University of Utah, Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Salt Lake City, Utah.

Abstract

Antibody-mediated rejection (AMR) is an increasingly recognized form of rejection and cause of graft failure after lung transplantation. AMR has been the focus of extensive research over the past decade. Despite growing awareness and recent advances in our understanding of AMR, outcomes remain dismal with a 2-year survival of only 20%. The International Society for Heart and Lung Transplantation convened a multidisciplinary workgroup of experts in AMR to review the most up-to-date research and clinical experience and to update the 2016 definition. The workgroup was divided into 9 subgroups covering a broad range of topics pertaining to AMR and used the modified Delphi method to synthesize a cohesive summary of the literature. A multidimensional definition was developed to enhance precision by reporting the specific presenting features. This Graft, Antibody, and Pathology (GAP) definition is based on the presence of Graft dysfunction, the presence and characteristics of Antibodies, and Pathological findings. The workgroup emphasized that identifying better treatments for AMR is a critical unmet need and proposed that a more precise definition might allow better management by providing a platform for testing and developing new therapies.

MeSH

Lung, Heart, Pathology, Heart Transplantation, Transplants, Research, Therapeutics, Lung Transplantation, Transplantation