Choose words that cast the mood most suitable for your discussion
Recently, I edited a paper that told a tricky story. A transplanted heart, an allograft, was rejected by the patient,
and the consulting hepatologist and pathologists had been missed the proper diagnosis - Humoral Rejection.
There was an explanation, not one that everyone would accept, but one that relieved these MDs from some of the
blame. Humoral rejection is not widely accepted in the cardiac literature, skepticism exists. The discussion I
wrote not only demonstrated this with examples, but the words I chose helped the reader to think this way:
Humoral rejection was first recognized in the cardiac allograft in 1989, yet some continue to question its
existence. Initially, HR was defined in EMBs as displaying capillary deposition of immunoglobulin and complement
by immunofluorescence and capillary endothelial cell swelling in hematoxylin-eosin-stained paraffin-embedded
tissue. However, the histologic light-microscopic features of HR have been inconsistent to date, ranging from
normal to cases displaying endothelial swelling, hemorrhaging, edema, and neutrophils that had been previously
attributed to “severe” (ISHLT grade 4) cellular rejection. Humoral rejection was not included in the original
ISHLT classification of rejection, and a revised version that addresses HR was only recently published.
Reservations also arise because one third of all rejection cases consist of mixed cellular rejection and HR.
Skeptics of HR most often propose ischemia as an alternate explanation for both the light microscopic findings
(when present) and the immunofluorescent findings. All in all, these observations demonstrate the uncertainty that
exists in the cardiac literature and partly explain the inability of pathologists and a hematologist to reach a
consensus diagnosis of HR for our case
"continue to question"
suggests lingering doubt
"only recently published"
implies too new to have