Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Antibody mediated rejection (AMR) is a form of allograft rejection triggered by the production of antibodies directed towards donor HLA molecules. It occurs in 10-20% of heart transplant recipients and is associated with increased graft loss, cardiac allograft vasculopathy (CAV) and increased risk of death. Additionally, the presence of donor specific antibodies regardless of evidence of rejection is associated with increased risk of developing CAV, graft loss, and mortality. Diagnosis of AMR is difficult and when AMR should be treated remains unclear.

Furthermore, treatment options for AMR after heart transplant are poorly studied and treatment algorithms not well-defined. This presentation will review the pathophysiology of antibody-mediated rejection after heart transplant, detail the complications of AMR and donor specific antibodies, and discuss literature regarding pharmacotherapy used to treat AMR in heart transplant recipients.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe the pathophysiology of antibody mediated rejection in heart transplant recipients.
• Identify complications from antibody mediated rejection and donor specific antibodies in heart transplant recipients.
• Discuss advantages and disadvantages of treatments for antibody mediated rejection in heart transplant recipients.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The assigned universal program number(s) is JA4008223-0000-23-097-H01-P .  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit.

Suggested Additional Reading & Joint Accreditation Statement:

Suggested Additional Reading:

1. Loupy A, Lefaucheur C. Antibody-Mediated Rejection of Solid-Organ Allografts. New Engl J Med. 2018; 379(12): 1150-60.
2. Kobashigawa J, et al. Report from a consensus-conference on antibody-mediated rejection in heart transplantation. J Heart Lung Transplant 2011;30:252–69.
3. Manfredini V, et al. Antibody-mediated rejection in heart transplantation: new developments and old uncertainties. Curr Opin Organ Transplant. 2017; 22(3):207-214.
4. Nauser CL, et al. Complement Recognition Pathways in Renal Transplantation. J Am Soc Nephrol. 2017; 28(9): 2571-2578.
5. Eskandary F et al. Complement inhibition as potential new-therapy for antibody-medaited rejection. Transpl Int. 2016; 29(4): 392-402.
6. Barten MJ, Zuckermann A. The meaning of donor-specific antibodies after heart transplant. Curr Opinion Organ Transplant. 2019; 24(3): 252-258.
7. Colvin MM, et al. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis an management: a scientific statement from the American Heart Association. Circulation. 2015; 131: 1608-1639.
8. Nikolova AP, Kobashigawa JA. Cardiac Allograft Vasculopathy: The Enduring Enemy of Cardiac Transplantation. Transplantation. 2019; 103(7):1338-1348
9. Su JA, et al. The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation. Curr Opin Organ Transplant. 2019; 24(3): 245-251.
10. Chih S, et al. A survey of current practice for antibody-mediated rejection in heart transplantation. Am J Transplant. 2013; 13: 1069-1074.
11. Ahmed S, Kaplan A. Therapeutic Plasma Exchange Using Membrane Plasma Separation. Clin J Am Soc Nephrol. 2020; 15(9): 1364-1370.
12. Grauhan et al. Plasmapheresis and cyclophosphamide in the treatment of humoral rejection after heart transplantation. J Heart Lung Transplant. 2001; 20(3): 316-21.
13. Crespo-Leiro et al. Humoral Heart Rejection: Incidence, Management, and the Value of C4d for Diagnosis. Am J Transplant. 2005; 5: 2560-2564.
14. Wang SS, et al. Effect of plasmapheresis on acute humoral rejection after heart transplantation. Transplant Proc. 2006; 38(10): 3692-4.
15. Linderfeld JA, et al. Drug Therapy in the Heart Transplant Recipient – Part II: Immunosuppressive Drugs. Circulation. 2004; 110(25): 3858-3865.
16. Levine MH, Abt PL. Treatment Options and Strategies for Antiboy-Mediated Rejection After Renal Transplantation. Semin Immunol. 2012; 24(2): 136-142.

Joint Accreditation Statement - this statement supersedes any other statement on this page
In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Pharmacy (CPE) - This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit.

Other Healthcare Professionals: Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.