Antibody-mediated renal allograft rejection: diagnosis and pathogenesis.
Alloantibodies to HLA class I or II and other antigens expressed by endothelium cause a variety of effects on renal transplants, ranging from acute to chronic rejection, and even apparent graft acceptance (accommodation). Recognition of these conditions and appropriate therapy requires demonstration of C4d in biopsies, commonly confirmed by tests for circulating alloantibody. Substantial practical experience by pathologists in the interpretation and pitfalls of C4d stains are reviewed along with considerations of the clinical significance and pathologic mechanisms of the different effects of antibody on the endothelium of the renal allograft. Clinical trials will be needed to ascertain the optimal treatment for the newly appreciated conditions chronic humoral rejection and accommodation.
Colvin
Robert B
RB
Pathology Department, Thier 831, Massachusetts General Hospital, Boston, MA 02114, USA. colvin@helix.mgh.harvard.edu
D000017:ABO Blood-Group System / Q000276:immunology; D000818:Animals; D000906:Antibodies / Q000276:immunology*; D015935:Complement C4b / Q000032:analysis; D003937:Diagnosis, Differential; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D010446:Peptide Fragments / Q000032:analysis; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D000906:Antibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d