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Humoral heart rejection (severe allograft dysfunction with no signs of cellular rejection or ischemia): incidence, management, and the value of C4d for diagnosis.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2005 Oct; Vol. 5 (10), pp. 2560-4. - Publication Year :
- 2005
-
Abstract
- Severe allograft dysfunction after heart transplant (HT), without ischemia or evidence of cellular rejection upon endomyocardial biopsy (EMB), is a rare but potentially fatal condition that suggests humoral rejection (HR). Its incidence, and the methods of choice for its diagnosis and management, remain uncertain. We retrospectively studied 445 HT patients (April 1991-December 2003) to determine incidence of HR diagnosed by clinical and conventional histopathological criteria. We used immunofluorescence (IF) techniques to test archived frozen EMB issue for IgM, IgG, C1q, C3, fibrin and C4d. Twelve patients (2.7%) fulfilled the criteria for HR after a mean time post-HT of 21.3 +/- 24.7 months (range: 2-72 months). Patients were treated with high doses of steroids and plasmapheresis, with successful recovery in 11 cases. IF studies using classical markers were mainly negative for the six patients with enough EMB tissue for testing. All six patients showed positivity for C4d during the HR episode but not before or after. Humoral rejection was observed in less than 3% of HT patients. Plasmapheresis treatment was highly effective. Classical IF tests were not useful for diagnosis, but C4d appears to be useful both for confirmation of diagnosis and for monitoring response to treatment.
- Subjects :
- Adult
Aged
Antigens, CD biosynthesis
Antigens, Differentiation, Myelomonocytic biosynthesis
Biomarkers
Biopsy
Complement C1q biosynthesis
Complement C3 biosynthesis
Female
Fibrin biosynthesis
Follow-Up Studies
Graft Survival
Humans
Immunoglobulin G biosynthesis
Immunoglobulin M biosynthesis
Ischemia
Male
Microscopy, Fluorescence
Middle Aged
Plasmapheresis
Retrospective Studies
Steroids therapeutic use
Time Factors
Transplantation, Homologous
Treatment Outcome
Antibody Formation physiology
Complement C4b biosynthesis
Graft Rejection
Heart Transplantation methods
Myocardium pathology
Peptide Fragments biosynthesis
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6135
- Volume :
- 5
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 16162208
- Full Text :
- https://doi.org/10.1111/j.1600-6143.2005.01039.x