心脏移植后抗体介导的急性排斥反应（AMR）经常合并血液动力学改变，且能够增加死亡率并加速移植物冠状动脉病变（TCAD）的发展。AMR的诊断曾经广受争议，且包括采用血浆置换和使用环磷酰胺等增强免疫抑制治疗的效果均不甚理想。诊断技术的改进诸如通过检测补体裂解产物C4d在组织中的沉积明确抗体介导的排斥反应的免疫病理学证据、以及通过流式细胞技术检测抗HLA抗体等手段能够帮助我们进一步了解AMR的特性。B淋巴细胞靶向免疫抑制以及使用mTOR抑制剂对于TCAD发生及提高AMR生存率方面的变化依然需要进一步证实。

Acute antibody-mediated rejection (AMR) in heart transplantation is often associated with hemodynamic compromise, and is associated with increased mortality and development of accelerated transplant coronary artery disease (TCAD). The diagnosis of AMR has historically been controversial and outcomes with aggressive immunosuppressive therapy including plasmapheresis and cyclophosphamide are poor. Advances in diagnostic techniques like the demonstration of immunopathologic evidence for antibody-mediated rejection by deposition of the complement split product C4d in tissue and detection of anti-HLA antibodies by flow cytometry will assist in further characterizing AMR. Immunosuppression targeting B-lymphocytes and use of m-TOR inhibitors to alter the predilection to develop TCAD and improve survival in AMR remains to be proven.

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