title: Histological markers of humoral rejection in renal transplant patients.
abstract: Diagnosis of "suspicious humoral rejection" can be formulated in the presence of peritubular capillary (PTC) C4d deposition and one of the following tissue changes: (1) acute tubular necrosis, (2) glomerulitis or presence of polymophonuclear leukocytes or monocytes in PTC, or (3) arteritis. From January 2004 to October 2006, we performed immunohistochemical staining with anti-C4d antibody on 54 renal biopsies from 39 renal transplant patients. In 25 biopsies we observed diffuse (n = 13) or focal (n = 12) C4d deposition. Based on C4d-positivity, patients were divided into three groups: group 1 included 19 C4d-negative patients; group 2, 10 patients with diffuse C4d-positivity; and group 3, 10 patients with focal C4d-positivity. Panel-reaction antibody-positive tests were associated with diffuse C4d-positivity: 50% of group 2 patients showed a positive test, while no group 1 or 3 patients had a positive test (P < .001). Glomerulitis was observed in six biopsies and associated with diffuse C4d staining. Graft loss occurred in 3/10 group 2 patients (30%); 2/19 group 1 patients (10.5%), and 1/10 group 3 patients (10%). Viral infections were experienced in the year of the biopsy by 50% of group 1 patients 80% of group 2 patients, and 100% of group 3 patients (P < .025), indicating a significantly greater number of infections among patients with C4d-positive biopsies. In eight cases, anti-thymocyte globulin was administered less than 21 days before the biopsy: four had diffuse and four had focal C4d positivity.
authors: Institute of Pathological Anatomy, University of Padua Medical School, Padua, Italy. marialuisa.valente@unipd.it
authors: M
authors: M
authors: Valente
authors: L
authors: L
authors: Furian
authors: S
authors: S
authors: Marino
authors: P
authors: P
authors: Rigotti
authors: N
authors: N
authors: De Fazio
authors: M
authors: M
authors: Cardillo
authors: R
authors: R
authors: Cusinato
authors: F B
authors: FB
authors: Aiello
mesh_terms: D000917:Antibody Formation; D015703:Antigens, CD / Q000097:blood; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001706:Biopsy; D015704:CD4 Antigens / Q000097:blood*; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology
chemical_list: D015703:Antigens, CD; D000961:Antilymphocyte Serum; D015704:CD4 Antigens; D007166:Immunosuppressive Agents