{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:48:58Z","timestamp":1753876138770,"version":"3.41.2"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:00:00Z","timestamp":1564531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background\u2003<\/jats:title>\n                  <jats:p>Very late antibody-mediated rejection (AMR) in heart transplant patients (over 10\u2009years post-transplant) is very rare. It is associated with high mortality, graft dysfunction, and fulminant coronary artery vasculopathy (CAV) and should remain in the differential for patients presenting with late graft dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary\u2003<\/jats:title>\n                  <jats:p>A 57-year-old woman 16\u2009years of post-heart transplant with a previously unremarkable post-transplant course including protocol driven biopsies showing no rejection and a recent unremarkable screening nuclear stress test presented to our institution with clinical heart failure. Echocardiogram revealed graft dysfunction and endomyocardial biopsy showed no signs of cellular rejection, but evidence of AMR. The patient was treated with steroid and immunotherapy with clinical improvement but suffered several infectious complications and renal dysfunction requiring haemodialysis related to her immunotherapy treatment. Despite aggressive AMR management, donor-specific antibodies and symptoms persisted and CAV progressed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion\u2003<\/jats:title>\n                  <jats:p>This case illustrates the poor diagnostic yield of non-invasive testing for AMR, and highlights importance to clinicians of considering AMR even if the patient over 10\u2009years post-transplant when the diagnosis is rare.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytz100","type":"journal-article","created":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T12:33:17Z","timestamp":1569587597000},"source":"Crossref","is-referenced-by-count":1,"title":["Antibody-mediated rejection 16 years post-cardiac transplantation: a case report of an uncommon late presentation in a middle-aged woman"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6168-259X","authenticated-orcid":false,"given":"Charles","family":"Miller","sequence":"first","affiliation":[{"name":"Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Knarik","family":"Arkun","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tufts Medical Center, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5698-5318","authenticated-orcid":false,"given":"David","family":"DeNofrio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9056-4210","authenticated-orcid":false,"given":"Marwa","family":"Sabe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,31]]},"reference":[{"key":"2019092712320959200_ytz100-B1","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1161\/CIR.0000000000000093","article-title":"AHA scientific statement: antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management","volume":"131","author":"Monia","year":"2015","journal-title":"Circulation"},{"key":"2019092712320959200_ytz100-B2","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.healun.2015.03.002","article-title":"Late antibody-mediated rejection after heart transplantation: mortality, graft function, and fulminant cardiac allograft vasculopathy","author":"Coutance","year":"2015","journal-title":"J Heart Lung Transplant"},{"key":"2019092712320959200_ytz100-B3","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.healun.2016.04.007","article-title":"The effect of timing and graft dysfunction on survival and cardiac allograft vasculopathy in antibody-mediated rejection","volume":"35","author":"Clerkin","year":"2016","journal-title":"J Heart Lung Transplant"},{"key":"2019092712320959200_ytz100-B4","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/S0002-8703(98)70062-6","article-title":"Noninvasive assessment of transplant-associated arteriosclerosis","volume":"135","author":"Fang","year":"1998","journal-title":"Am Heart J"},{"key":"2019092712320959200_ytz100-B5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1600-6143.2008.02474.x","article-title":"Cardiac allograft remodeling after heart transplantation is associated with increased graft vasculopathy and mortality","volume":"9","author":"Raichlin","year":"2008","journal-title":"Am J Transplant"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/3\/3\/ytz100\/30068762\/ytz100.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T12:33:20Z","timestamp":1569587600000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytz100\/5542046"}},"subtitle":[],"editor":[{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Bonaros","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Francesca","family":"Musella","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Rahul","family":"Mukherjee","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Peregrine","family":"Green","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2019,7,31]]},"references-count":5,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,7,31]]},"published-print":{"date-parts":[[2019,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytz100","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2019,9]]},"published":{"date-parts":[[2019,7,31]]},"article-number":"ytz100"}}