High Specificity of C4d/CD68 Staining for the Diagnosis of Late Antibody-Mediated Rejection in Heart Transplantation.
Details
Serval ID
serval:BIB_6FB0640A2595
Type
Inproceedings: an article in a conference proceedings.
Publication sub-type
Poster: Summary – with images – on one page of the results of a researche project. The summaries of the poster must be entered in "Abstract" and not "Poster".
Collection
Publications
Institution
Title
High Specificity of C4d/CD68 Staining for the Diagnosis of Late Antibody-Mediated Rejection in Heart Transplantation.
Title of the conference
9th Joint Meeting of the American Society of Transplant Surgeon and of the American Society of Transplantation
Address
Boston, Massachusetts, May 30-June 3, 2009
ISBN
1600-6135
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
9
Series
American Journal of Transplantation
Pages
656
Language
english
Notes
Publication type : Meeting Abstract
Abstract
In heart transplantation (HTx), acute antibody-mediated rejection (AMR) is
infrequent but carries high mortality and increased risk of graft vasculopathy.
The diagnosis requires evidence of acute graft dysfunction, capillary lesions on
endomyocardial biopsy (EMB), and immunopathological criteria of antibodymediated
injury. Multiple markers of antibody-mediated injuries have been proposed,
but there is ample debate on their usefulness. In kidney transplantation, C4d
deposition in peritubular capillaries is a reliable marker of alloantibody-dependant
graft injury. In this study, we prospectively screened all EMBs for C4d and CD68
in new HTx recipients, and correlated pathological fi ndings with immunological
evidence of donor-specifi c antibodies (DSA) and graft dysfunction.
Methods
Between Nov 05 and Aug 08, we had 22 HTx, and 17 cases were analysed. All
recipients received polyclonal rabbit anti-thymocytes globulin, calcineurin inhibitors,
mycophenolate mofetil, and corticosteroids (weaning in 6 -12 months). They had
EMB every 1-2 weeks in the fi rst 3 months, and then monthly for 9 months. C4d and
CD 68 were assessed by immunochemistry. Echocardiography and DSA assessment
or crossmatch (early phase) were realised if C4d or CD68 staining was positive.
Results
There was 1 early and 1 late AMR.
Table 1
C4d and CD68 positive, at least 1 EMB 6 / 17; 35% 1 treated
C4d and CD68 positive, at least 2 consecutive EMBs 3 / 17; 17.5% 1 treated
C4d and CD68 positive, and graft dysfunction 1 / 17; 6% 1 treated
C4d and CD68 positive, with DSA and crossmatch + 1 / 17; 6% 1 treated
Table 2
C4d and CD68 positive, at least 1 EMB 1 / 17; 6% 1 treated
C4d and CD68 positive, at least 2 consecutive EMBs 1 /17; 6% 1 treated
C4d and CD68 positive and graft dysfunction 1 / 17; 6% 1 treated
C4d and CD68 positive, and + DSA 1 / 17; 6% 1 treated
Conclusion
In this single-center experience, C4d / CD68 positive staining was frequent in the
early phase and raised the question of false positive cases of AMR. However, these
markers showed high specifi city for the diagnosis of AMR in the late phase. Of
course these data need to be confi rmed in larger multi-center studies.
infrequent but carries high mortality and increased risk of graft vasculopathy.
The diagnosis requires evidence of acute graft dysfunction, capillary lesions on
endomyocardial biopsy (EMB), and immunopathological criteria of antibodymediated
injury. Multiple markers of antibody-mediated injuries have been proposed,
but there is ample debate on their usefulness. In kidney transplantation, C4d
deposition in peritubular capillaries is a reliable marker of alloantibody-dependant
graft injury. In this study, we prospectively screened all EMBs for C4d and CD68
in new HTx recipients, and correlated pathological fi ndings with immunological
evidence of donor-specifi c antibodies (DSA) and graft dysfunction.
Methods
Between Nov 05 and Aug 08, we had 22 HTx, and 17 cases were analysed. All
recipients received polyclonal rabbit anti-thymocytes globulin, calcineurin inhibitors,
mycophenolate mofetil, and corticosteroids (weaning in 6 -12 months). They had
EMB every 1-2 weeks in the fi rst 3 months, and then monthly for 9 months. C4d and
CD 68 were assessed by immunochemistry. Echocardiography and DSA assessment
or crossmatch (early phase) were realised if C4d or CD68 staining was positive.
Results
There was 1 early and 1 late AMR.
Table 1
C4d and CD68 positive, at least 1 EMB 6 / 17; 35% 1 treated
C4d and CD68 positive, at least 2 consecutive EMBs 3 / 17; 17.5% 1 treated
C4d and CD68 positive, and graft dysfunction 1 / 17; 6% 1 treated
C4d and CD68 positive, with DSA and crossmatch + 1 / 17; 6% 1 treated
Table 2
C4d and CD68 positive, at least 1 EMB 1 / 17; 6% 1 treated
C4d and CD68 positive, at least 2 consecutive EMBs 1 /17; 6% 1 treated
C4d and CD68 positive and graft dysfunction 1 / 17; 6% 1 treated
C4d and CD68 positive, and + DSA 1 / 17; 6% 1 treated
Conclusion
In this single-center experience, C4d / CD68 positive staining was frequent in the
early phase and raised the question of false positive cases of AMR. However, these
markers showed high specifi city for the diagnosis of AMR in the late phase. Of
course these data need to be confi rmed in larger multi-center studies.
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Create date
27/07/2010 15:55
Last modification date
20/08/2019 14:28
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