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The impact of C 4d and microvascular inflammation before we knew them
Author(s) -
Verghese Priya,
Dunn Ty,
Najafian Behzad,
Kim Youngki,
Matas Arthur
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12111
Subject(s) - medicine , biopsy , gastroenterology , surgery , pathology
It is important to identify prognostically important morphologic criteria in post‐transplant management to tailor therapy and improve outcomes. Therefore, using biopsies carried out for cause <1‐yr post‐transplant, from an era when C 4d staining and microvascular inflammation ( MVI ) were not clinically utilized, we studied the importance of C 4d and MVI on graft survival. Snap‐frozen first renal allograft biopsy specimens (done for cause) in the first post‐transplant year from 1996 to 2001 were stained/examined for C 4d, and pathology re‐examined by a separate blinded pathologist. Graft outcomes in patients with and without MVI and/or C 4d were compared. Of 128 patients, 39 (30.5%) biopsies were C 4d+ and 89 (69.5%) were C 4d−; 67 (52.3%) had no MVI ( MVI −) while 61 (47.7%) had glomerulitis, peritubular capillaritis, or both ( MVI +). There were no significant demographic differences between MVI + and MVI − patients. A greater proportion of C 4d+ biopsies was MVI + (67%) than MVI − (33%; p = 0.004). C 4d positivity had no impact on death‐censored graft survival ( DCGS ). In contrast DCGS was worse in MVI + than MVI − regardless of presence/absence of C 4d (p = 0.005). In biopsies for cause carried out <1‐yr post‐transplant, MVI is associated with decreased DCGS , independent of the presence of C 4d.