Back to Search
Start Over
C4d-positive renal allograft rejection biopsies in cyclosporine-treated patients: single-center incidence and outcome.
- Source :
-
Transplantation proceedings [Transplant Proc] 2010 Jul-Aug; Vol. 42 (6), pp. 2214-7. - Publication Year :
- 2010
-
Abstract
- T cell-mediated acute rejection (ATCMR) in renal transplant patients can have an antibody-mediated component. The aim of this study was to evaluate the incidence of renal biopsies showing ATCMR with C4d immunoreactivity and the correlation between C4d-positive ATCMRs and graft outcomes. We studied 216 renal transplant patients receiving cyclosporine-based immunosuppression (mean follow-up = 203.5 +/- 42.5 months). Of these, 79 experienced biopsy-proven ATCMR (group 1), whereas 137 did not show clinical or laboratory evidence of ATCMR (group 2). Mean serum creatinine levels were evaluated at 6 months, as well as 2 and 5 years after transplantation. The number of graft losses due to interstitial fibrosis and tubular atrophy (IF/TA) was greater in group 1 than in group 2 (P < .001 and P < .02, respectively), while graft survival was lower (P < .03). Staining with anti-C4d antibody was performed in 61/77 type I ATCMR biopsies: seven cases showed diffuse C4d positivity with CD68(+) monocytes in peritubular capillaries observed in all cases. Three cases showed focal C4d positivity. Two ATCMRs were steroid, resistant. Graft loss due to IF/TA occurred in 4/7 patients (57.1%) who had previously experienced ATCMRs with diffuse C4d positivity; whereas it occurred in 5/51 patients (9.8%) with previous C4d negative ATCMRs (P < .001). Patients with focal C4d positivity did not undergo graft loss due to IF/TA. In conclusion, at our center the diffuse C4d positivity that occurred in 11.4% of type I ATCMRs was associated with a poor prognosis.<br /> (Copyright 2010 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Biopsy
Creatinine blood
Female
Follow-Up Studies
Graft Rejection epidemiology
Graft Rejection immunology
Histocompatibility Testing methods
Humans
Incidence
Kidney Transplantation mortality
Kidney Transplantation pathology
Kidney Transplantation physiology
Male
Middle Aged
Retrospective Studies
Survival Rate
Treatment Outcome
Complement C4b analysis
Graft Rejection pathology
Kidney Transplantation immunology
Peptide Fragments analysis
T-Lymphocytes immunology
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 42
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 20692447
- Full Text :
- https://doi.org/10.1016/j.transproceed.2010.05.037