Pancreas allograft biopsies with positive c4d staining and anti-donor antibodies related to worse outcome for patients.
C4d+ antibody-mediated rejection following pancreas transplantation has not been well characterized. Therefore, we assessed the outcomes of 27 pancreas transplantation patients (28 biopsies), with both C4d staining and donor-specific antibodies (DSA) determined, from a cohort of 257 patients. The median follow-up was 50 (interquartile range [IQR] 8-118) months. Patients were categorized into 3 groups: group 1, patients with minimal or no C4d staining and no DSA (n = 13); group 2, patients with either DSA present but no C4d, diffuse C4d+ and no DSA or focal C4d+ and DSA (n = 6); group 3, patients with diffuse C4d+ staining and DSA (n = 9). Active septal inflammation, acinar inflammation and acinar cell injury/necrosis were significantly more abundant in group 3 than in group 2 (respective p-values: 0.009; 0.033; 0.025) and in group 1 (respective p-values: 0.034; 0.009; 0.002). The overall uncensored pancreas graft survival rate for groups 1, 2 and 3 were 53.3%, 66.7% and 34.6%, respectively (p = 0.044). In conclusion, recipients of pancreas transplants with no C4d or DSA had excellent long-term graft survival in comparison with patients with both C4d+ and DSA present. Hence, C4d should be used as an additional marker in combination with DSA in the evaluation of pancreas transplant biopsies.
de Kort
H
H
Department of Pathology, Leiden University Medical Center, The Netherlands. H.de_Kort@lumc.nl
Munivenkatappa
R B
RB
Berger
S P
SP
Eikmans
M
M
van der Wal
A
A
de Koning
E J
EJ
van Kooten
C
C
de Heer
E
E
Barth
R N
RN
Bruijn
J A
JA
Philosophe
B
B
Drachenberg
C B
CB
Bajema
I M
IM
D000328:Adult; D001706:Biopsy; D004396:Coloring Agents; D015935:Complement C4b / Q000032:analysis*; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000473:pathology*; D006680:HLA Antigens / Q000032:analysis; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000473:pathology*; D010446:Peptide Fragments / Q000032:analysis*; D011183:Postoperative Complications / Q000276:immunology / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous / Q000473:pathology; D016896:Treatment Outcome
D004396:Coloring Agents; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d