The Approach to Antibodies After Heart Transplantation.

a Purpose of review: This review summarizes recent data about antibodies after cardiac transplantation; what testing modalities are available and how frequently to employ them; as well as when treatment is necessary.

b Recent findings: Technologies available for antibody detection have progressed over the past couple decades. New and preformed antibodies are associated with worse outcomes in transplant recipients.

c Summary: The frequency of screening for post-transplant antibodies and for antibody-mediated rejection (AMR) should be based on risk stratification. The presence of antibodies alone post-transplant does not constitute a diagnosis of AMR. Treatment of post-transplant antibodies and AMR should be made in conjunction with consideration of AMR grade and graft dysfunction. Future directions will involve improved detection methods and further understanding of non-HLA antibodies and de novo antibodies in the post-transplant population. Additionally, aggressive efforts are currently underway to provide more therapeutic options.