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Significance of C 4d deposition in antibody‐mediated rejection
Author(s) -
Takeda Asami,
Otsuka Yasuhiro,
Horike Keiji,
Inaguma Daijo,
Hiramitsu Takahisa,
Yamamoto Takayuki,
Nanmoku Koji,
Goto Norihiko,
Watarai Yoshihiko,
Uchida Kazuharu,
Morozumi Kunio,
Kobayashi Takaaki
Publication year - 2012
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.1399-0012.2012.01642.x
Subject(s) - medicine , peritubular capillaries , pathology , staining , abo blood group system , transplantation , biopsy , glomerulopathy , kidney , glomerulonephritis
The C 4d staining as a special tissue marker for humoral immunity has served criteria of pathological diagnosis for antibody‐mediated rejection ( ABMR ) in B anff classification since 2003. However, the sensitivity and specificity of C 4d staining have been questioned, and recently, C 4d‐negative ABMR has been more focused in renal allograft pathology. The aim of this study was to make certain of C 4d staining for ABMR that was diagnosed by clinical and morphological findings. C 4d staining was employed by immunofluorescence. This study included 14 patients with acute ABMR and 16 with chronic active ABMR . Eight of acute ABMR were ABO ‐blood‐type‐incompatible renal transplantation ( ABO in RT x) pre‐treated by DFPP and splenectomy or rituximub. In acute ABMR after ABO in RT x, C 4d staining along peritubular capillary ( PTC ) was positive in five of them (62.5%). Only one graft biopsy of five acute ABMR with donor‐specific antibody ( DSA ) showed C 4d positive. We assembled 16 graft biopsies showing typical transplant glomerulopathy and thickened PTC basement membrane with peritubular capillaritis as a suspicious pathological chronic active ABMR . Four of eight DSA ‐positive patients were C 4d negative in PTC ; however, three of four DSA ‐positive and C 4d‐negative patients in PTC chronic active ABMR were C 4d positive in only glomerular capillaries. C 4d positivity could not come to a specific marker of ABMR diagnosing based on clinically and ordinary morphological findings.