The Expression of C4d and HLA-DR in Renal Allografts with the Histologic Features of Antibody-Mediated Rejection
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : Deposition of C4d along the peritubular capillaries is generally associated with an antibody-mediated response. We evaluated, with performing C4d immunostaining, the diagnostic accuracy of the cases that were previously diagnosed as antibody-mediated rejection (ABMR) when based only on the histologic findings, and we examined possible correlation of C4d with HLA-DR. Methods : Forty-five renal transplantation biopsies, which showed ABMR-like histology, were obtained. The expressions of C4d and HLA-DR in the transplant rejection cases were investigated using immunofluorescent and/or immunohistochemical staining. Results : There were 14 discordant cases among a total of 45 cases when C4d was used as a diagnostic marker and the original slides were reviewed. These total cases consisted of the C4d negative cases in two cases of hyperacute rejection and all the cases of ABMR and ABMR with chronic/sclerosing allograft nephropathy (CAN) and two C4d positive cases (one each of acute cellular rejection (ACR) and CAN according to their original diagnosis) and all these cases were then revised according to Banff 07. The expression of HLA-DR tended to be correlated with the log-transformed duration of grafts until three years after the transplantation. Conclusions : This study demonstrates that C4d together with the histologic findings should be used for making the diagnosis of ABMR. The tubular HLA-DR expression over time should be studied to further understand the mechanism of graft rejection.
Abstract
Background : Deposition of C4d along the peritubular capillaries is generally associated with an antibody-mediated response. We evaluated, with performing C4d immunostaining, the diagnostic accuracy of the cases that were previously diagnosed as antibody-mediated rejection (ABMR) when based only on the histologic findings, and we examined possible correlation of C4d with HLA-DR. Methods : Forty-five renal transplantation biopsies, which showed ABMR-like histology, were obtained. The expressions of C4d and HLA-DR in the transplant rejection cases were investigated using immunofluorescent and/or immunohistochemical staining. Results : There were 14 discordant cases among a total of 45 cases when C4d was used as a diagnostic marker and the original slides were reviewed. These total cases consisted of the C4d negative cases in two cases of hyperacute rejection and all the cases of ABMR and ABMR with chronic/sclerosing allograft nephropathy (CAN) and two C4d positive cases (one each of acute cellular rejection (ACR) and CAN according to their original diagnosis) and all these cases were then revised according to Banff 07. The expression of HLA-DR tended to be correlated with the log-transformed duration of grafts until three years after the transplantation. Conclusions : This study demonstrates that C4d together with the histologic findings should be used for making the diagnosis of ABMR. The tubular HLA-DR expression over time should be studied to further understand the mechanism of graft rejection.
참고문헌 (20)
- Mengel M, "Incidence of C4d stain in protocol biopsies from renal allografts: results from a multicenter trial", Am J Transplant, 5, pp.1050~1056 (2005)
- Feucht HE, "Capillary deposition of C4d complement fragment and early renal graft loss", 43, pp.1333~1338 (1993)
- Herzenberg AM, "C4d deposition in acute rejection: an independent long-term prognostic factor", J Am Soc Nephrol, 13, pp.234~241 (2002)
- Mauiyyedi S, "Acute humoral rejection in kidney transplantation: II. Morphology, immunopathology, and pathologic classification", J Am Soc Nephrol, 13, pp.779~787 (2002)
- Nickeleit V, "Detection of the complement degradation product C4d in renal allografts: diagnostic and therapeutic implications", J Am Soc Nephrol, 13, pp.242~251 (2002)
- Racusen LC, "Banff 2003 meeting report: new diagnostic insights and standards", Am J Transplant, 4, pp.1562~1566 (2004)
- Bohmig GA, "C4d deposits in renal allografts are associated with inferior graft outcome", Transplant Proc, 33, pp.1151~1152 (2001)
- Nickeleit V, "Kidney transplants, antibodies and rejection: is C4d a magic marker?", Nephrol Dial Transplant, 18, pp.2232~2239 (2003)
- Terasaki PI, "Humoral theory of transplantation: further evidence", Curr Opin Immunol, 17, pp.541~545 (2005)
- Mauiyyedi S, "Chronic humoral rejection: identification of antibody-mediated chronic renal allograft rejection by C4d deposits in peritubular capillaries", J Am Soc Nephrol, 12, pp.574~582 (2001)
- Sun Q, "Late and early C4d-positive acute rejection: different clinico-histopathological subentities in renal transplantation", Kidney Int, 70, pp.377~383 (2006)
- Kim WS, "Pre dictive value of an immunohistochemical staining for HLA-DR, ICAM-1 and VCAM-1 in acute renal allograft rejection", J Korean Soc Transplant, 15, pp.151~157 (2001)
- Racusen LC, "The Banff 97 working classification of renal allograft pathology", Kidney Int, 55, pp.713~723 (1999)
- Solez K, "Banff 07 classification of renal allograft pathology: updates and future directions", Am J Transplant, 8, pp.753~760 (2008)
- 권오완, "Rituximab과 혈장교환술로 치료한 C4d-양성 급성 항체매개 거부반응 1예", Kidney Research and Clinical Practice, 25(2), pp.337~342 (2006), 대한신장학회
- Onitsuka S, "Peritubular capillary deposition of C4d complement fragment in ABOincompatible renal transplantation with humoral rejection", Clin Transplant, 13, pp.33~37 (1999)
- Hall BM, "Increased expression of HLA-DR antigens on renal tubular cells in renal transplants: relevance to the rejection response", Lancet, 2, pp.247~251 (1984)
- Nadasdy GM, "Comparative study for the detection of peritubular capillary C4d deposition in human renal allografts using different methodologies", Hum Pathol, 36, pp.1178~1185 (2005)
- Seemayer CA, "C4d staining of renal allograft biopsies: a comparative analysis of different staining techniques", Nephrol Dial Transplant, 22, pp.568~576 (2007)
- Gonzalez-Posada JM, "HLADR class II and ICAM-1 expression on tubular cells taken by fineneedle aspiration biopsy in renal allograft dysfunction", Nephrol Dial Transplant, 11, pp.148~152 (1996)