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Current problems of chronic active antibody‐mediated rejection
Author(s) -
Takeda Asami,
Horike Keiji,
Ohtsuka Yasuhiro,
Inaguma Daijo,
Goto Norihiko,
Watarai Yoshihiko,
Uchida Kazuharu,
Morozumi Kunio
Publication year - 2011
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/j.1399-0012.2011.01451.x
Subject(s) - medicine , basement membrane , antibody , pathology , staining , immunology
Takeda A, Horike K, Ohtsuka Y, Inaguma D, Goto N, Watarai Y, Uchida K, Morozumi K. Current problems of chronic active antibody‐mediated rejection.
Clin Transplant 2011: 25 (Suppl. 23): 2–5.
© 2011 John Wiley & Sons A/S. Abstract: The Banff 2007 classification allows chronic rejection to be differentiated based on clinicopathological characteristics evidenced by two independent immunologic mechanisms; chronic active antibody‐mediated rejection and chronic active T‐lymphocyte mediated rejection. However, several incompletely understood issues concerning chronic active antibody‐mediated rejection remain. Chronic active antibody‐mediated rejection is characterized by C4d deposition in the capillary basement membrane(PTC), the presence of circulating anti‐donor antibodies(DSA), and morphologic evidence of chronic tissue injury such as glomerular double contours compatible with transplant glomerulopathy (TPG), PTC basement membrane multilayering, interstitial fibrosis/tubular atrophy, and fibrous arterial intimal thickening. PTC basement membrane multilayering correlates highly with TPG, and most of TPG have evidence of either C4d‐positive staining or DSA. However, the proposed criteria do not apply to all situations of chronic active antibody‐mediated rejection. C4d is not a magic marker for antibody‐mediated rejection. C4d staining is not always highly sensitive for detecting antibody‐mediated rejection. Multi‐institutional studies should be conducted to better understand the clinicopathological context of chronic antibody‐mediated rejection. These studies should include well‐designed serial protocol biopsies with evaluation by electron microscopy, C4d staining performed on frozen sections, and assessment using sensitive DSA detection methods.