The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation

J Heart Lung Transplant. 2013 Dec;32(12):1147-62. doi: 10.1016/j.healun.2013.08.011.


During the last 25 years, antibody-mediated rejection of the cardiac allograft has evolved from a relatively obscure concept to a recognized clinical complication in the management of heart transplant patients. Herein we report the consensus findings from a series of meetings held between 2010-2012 to develop a Working Formulation for the pathologic diagnosis, grading, and reporting of cardiac antibody-mediated rejection. The diagnostic criteria for its morphologic and immunopathologic components are enumerated, illustrated, and described in detail. Numerous challenges and unresolved clinical, immunologic, and pathologic questions remain to which a Working Formulation may facilitate answers.

Keywords: activated mononuclear cells; antibody mediated rejection; complement; heart; immunofluorescence; immunohistochemistry; intravascular.

Publication types

  • Consensus Development Conference
  • Editorial

MeSH terms

  • Antibodies / immunology*
  • Antigens, CD / immunology
  • Antigens, Differentiation, Myelomonocytic / immunology
  • Complement C3d / immunology
  • Graft Rejection / diagnosis*
  • Graft Rejection / immunology*
  • Graft Rejection / pathology
  • Heart Transplantation*
  • Humans
  • Immunophenotyping
  • International Cooperation
  • Terminology as Topic*


  • Antibodies
  • Antigens, CD
  • Antigens, Differentiation, Myelomonocytic
  • CD68 antigen, human
  • Complement C3d