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CD68/CD31 immunohistochemistry double stain demonstrates increased accuracy in diagnosing pathologic antibody-mediated rejection in cardiac transplant patients.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2019 Nov; Vol. 19 (11), pp. 3149-3154. Date of Electronic Publication: 2019 Sep 09. - Publication Year :
- 2019
-
Abstract
- Pathologic antibody-mediated rejection (pAMR) occurs in 10% of cardiac transplant patients and is associated with increased mortality. The endomyocardial biopsy remains the primary diagnostic tool to detect and define pAMR. However, certain challenges arise for the pathologist. Accurate identification of >10% of intravascular macrophages along with endothelial swelling, which remains a critical component of diagnosing pAMR, is one such challenge. We used double labeling with an endothelial and histiocytic marker to improve diagnostic accuracy. Twenty-two cardiac transplant endomyocardial biopsies were screened using a CD68/CD31 immunohistochemical (IHC) double stain. To determine whether pAMR diagnosis would change using the double stain, intravascular macrophage staining was compared to using CD68 alone. Twenty-two cardiac pAMR cases from patients were included. Fifty-nine percent of cases previously called >10% intravascular macrophage positive by CD68 alone were called <10% positive using the CD68/CD31 double stain. Not using the double stain was associated with a significant overcall. In C4d-negative cases, using the CD68/CD31 double stain downgraded the diagnosis of pAMR2 to pAMR1 in 32% of cases. It was concluded that more than one third of patients were overdiagnosed with pAMR using CD68 by IHC alone. We demonstrate the value of using a CD68/CD31 double stain to increase accuracy.<br /> (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Female
Follow-Up Studies
Graft Rejection etiology
Graft Rejection metabolism
Graft Survival
Humans
Immunohistochemistry
Macrophages immunology
Macrophages metabolism
Macrophages pathology
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Factors
Tissue Donors
Antigens, CD metabolism
Antigens, Differentiation, T-Lymphocyte metabolism
Biomarkers metabolism
Graft Rejection diagnosis
Heart Transplantation adverse effects
Isoantibodies adverse effects
Lectins, C-Type metabolism
Platelet Endothelial Cell Adhesion Molecule-1 metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 19
- Issue :
- 11
- 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 :
- 31339651
- Full Text :
- https://doi.org/10.1111/ajt.15540