Glomerular C4d Immunoreactivity in Acute Rejection Biopsies of Renal Transplant Patients

被引:11
作者
Valente, M. [1 ]
Furian, L. [2 ]
Della Barbera, M. [1 ]
Silvestre, C. [2 ]
Marino, S. [3 ]
Seveso, M. [2 ]
Cozzi, E. [2 ]
Rigotti, P. [2 ]
Aiello, F. B. [4 ]
机构
[1] Univ Padua, Dept Med Diagnost Sci & Special Therapies, I-35121 Padua, Italy
[2] Univ Padua, Dept Surg & Gastroenterol Sci, I-35121 Padua, Italy
[3] Az ULSS Veneziana, Dept Mental Hlth, Venice, Italy
[4] Univ G dAnnunzio, Dept Med & Aging Sci, Chieti, Italy
关键词
ALLOGRAFT REJECTION; ANTIBODY; CLASSIFICATION; DEPOSITION; CAPILLARY; FEATURES; RISK;
D O I
10.1016/j.transproceed.2012.07.062
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
In renal transplant patients, glomerulitis may be present in all types of acute rejection, often accompanied by diffuse C4d staining of peritubular capillaries: C4d3 positivity in more than 50% of peritubular capillaries. It may progress to chronic transplant glomerulopathy, characterized by capillary basement membrane multilayering, proteinuria, and progressive loss of renal function. While C4d3 is a recognized marker of an antibody-mediated reaction, the significance of glomerular C4d (GlC4d) staining is unknown. The aim of this study was to evaluate GlC4d immunoreactivity and its correlation with C4d3 in acute rejection biopsies. Paraffin-embedded acute rejection biopsies from 90 renal transplant patients were evaluated according to the Banff classification. Biopsies showing C4d-positive endothelial cells in more than 50% of glomeruli were considered GlC4d-positive. C4d3-positive staining prevalence was 23%. GlC4d-positive staining showed an 89% concordance rate (r = 0.81, P < .0001; Cohen's k = 0.80, P < .0001). GlC4d detection sensitivity was 0.80 and specificity 0.97. C4d3 and GlC4d immunoreactivity was significantly associated with glomerulitis (P < .006 and P < .03, respectively) and with proteinuria at the time of biopsy (P < .03 and P <.01, respectively). Interestingly, GlC4d positivity correlated better than C4d3 positivity with the presence of posttransplant circulating anti-human leukocyte antigen alloantibodies (P < .04 and P = .7, respectively). Patients with C4d3- or GlC4d-positive acute rejections underwent graft loss due to interstitial fibrosis and tubular atrophy more frequently than those with C4d0- or GlC4d-negative rejections (P < .0001 and P < .005, respectively), whereas no differences were observed in graft loss due to death. In conclusion, C4d3 and G1C4d stains showed a high correlation rate. Compared with C4d3, GlC4d staining demonstrated good sensitivity and excellent specificity. Our results suggested that GlC4d staining may indicate glomerular endothelial damage and be of prognostic value.
引用
收藏
页码:1897 / 1900
页数:4
相关论文
共 16 条
[1]   Renal allograft biopsies in the era of C4d staining: the need for change in the Banff classification system [J].
Al-Aly, Ziyad ;
Reddivari, Venkata ;
Moiz, Abdul ;
Balasubramanian, Geetha ;
Cortese, Cherise M. ;
Salinas-Madrigal, Luis ;
Bastani, Bahar .
TRANSPLANT INTERNATIONAL, 2008, 21 (03) :268-275
[2]  
Böhmig GA, 2002, J AM SOC NEPHROL, V13, DOI 10.1681/ASN.V1341091
[3]   Antibody-mediated renal allograft rejection: Diagnosis and pathogenesis [J].
Colvin, Robert B. .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2007, 18 (04) :1046-1056
[4]   Transplant glomerulopathy [J].
Cosio, F. G. ;
Gloor, J. M. ;
Sethi, S. ;
Stegall, M. D. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2008, 8 (03) :492-496
[5]   Features of acute rejection that increase risk for chronic rejection [J].
Humar, A ;
Kerr, S ;
Gillingham, KJ ;
Matas, AJ .
TRANSPLANTATION, 1999, 68 (08) :1200-1203
[6]   Significance of Peritubular Capillary, Glomerular, and Arteriolar C4d Staining Patterns in Paraffin Sections of Early Kidney Transplant Biopsies [J].
Kikic, Zeljko ;
Regele, Heinz ;
Nordmeyer, Veit ;
Wahrmann, Markus ;
Kletzmayr, Josef ;
Bartel, Gregor ;
Boehmig, Georg A. .
TRANSPLANTATION, 2011, 91 (04) :440-446
[7]   Significance of C4d Banff Scores in Early Protocol Biopsies of Kidney Transplant Recipients with Preformed Donor-Specific Antibodies (DSA) [J].
Loupy, A. ;
Hill, G. S. ;
Suberbielle, C. ;
Charron, D. ;
Anglicheau, D. ;
Zuber, J. ;
Timsit, M. O. ;
Duong, J. P. ;
Bruneval, P. ;
Vernerey, Dewi ;
Empana, J. P. ;
Jouven, X. ;
Nochy, D. ;
Legendre, C. H. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2011, 11 (01) :56-65
[8]   Acute rejection and late renal transplant failure: Risk factors and prognosis [J].
Mateu, LMP ;
Calabuig, AS ;
Plaza, LC ;
Esteve, AF .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2004, 19 :38-42
[9]  
Mauiyyedi S, 2002, J AM SOC NEPHROL, V13, DOI 10.1681/ASN.V133779
[10]   Antibody-mediated rejection criteria - an addition to the Banff '97 Classification of Renal Allograft Rejection [J].
Racusen, LC ;
Colvin, RB ;
Solez, K ;
Mihatsch, MJ ;
Halloran, PF ;
Campbell, PM ;
Cecka, MJ ;
Cosyns, JP ;
Demetris, AJ ;
Fishbein, MC ;
Fogo, A ;
Furness, P ;
Gibson, IW ;
Glotz, D ;
Hayry, P ;
Hunsickern, LN ;
Kashgarian, M ;
Kerman, R ;
Magil, AJ ;
Montgomery, R ;
Morozumi, K ;
Nickeleit, V ;
Randhawa, P ;
Regele, H ;
Seron, D ;
Seshan, S ;
Sund, S ;
Trpkov, K .
AMERICAN JOURNAL OF TRANSPLANTATION, 2003, 3 (06) :708-714