title: Acute vascular humoral rejection in a sensitized cardiac graft recipient: diagnostic value of C4d immunofluorescence.
abstract: A 37-year-old female patient had a cardiac transplantation for dilated cardiomyopathy. She was sensitized by two pregnancies showing anti-human leukocyte antigen I and II antibodies. The pretransplantation crossmatch was negative, but she developed acute humoral rejection characterized by vascular C4d deposits, arteriolitis, and intravascular leukocyte accumulation and adhesion in venules. Although C4d deposits disappeared in 4 weeks, she had persistent endothelial cell activation (endothelial expression of ELAM-1, VCAM-1, or human leukocyte antigen class II) throughout the 6 months of follow-up. Although she received intensive immunosuppression, she presented three episodes of acute cellular rejection during that period of time. This case shows that C4d deposits represent a sensitive marker of acute humoral rejection in cardiac transplantation. Therefore, C4d immunofluorescence should be more frequently assessed in endomyocardial biopsies.
authors.affiliation: Department of Pathology, Unit of Cardiac Transplantation, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Duong Van Huyen
authors.forename: Paul
authors.initials: P
authors.lastname: Fornes
authors.forename: Romain
authors.initials: R
authors.lastname: Guillemain
authors.forename: Catherine
authors.initials: C
authors.lastname: Amrein
authors.forename: Patrick
authors.initials: P
authors.lastname: Chevalier
authors.forename: Christian
authors.initials: C
authors.lastname: Latremouille
authors.forename: Caroline
authors.initials: C
authors.lastname: Creput
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
authors.forename: Dominique
authors.initials: D
authors.lastname: Nochy
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D015704:CD4 Antigens / Q000378:metabolism; D003331:Coronary Vessels / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D004699:Endocardium / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D004730:Endothelium, Vascular / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D005260:Female; D005455:Fluorescent Antibody Technique; D006084:Graft Rejection / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology / Q000473:pathology*; D006801:Humans; D014184:Transplantation, Homologous
chemical_list: D015415:Biomarkers; D015704:CD4 Antigens