title: Currently available useful immunohistochemical markers of renal pathology for the diagnosis of renal allograft rejection.
abstract: Renal allograft dysfunction may be induced by various causes, including alloimmune rejection, viral infection, urinary tract obstruction, calcineurin inhibitor nephrotoxicity and/or recurrent renal disease. In order to determine the underlying cause, a renal biopsy is performed and the renal transplant pathology is diagnosed using the internationally consensus Banff classification. Although a progressive understanding of allograft rejection has provided numerous immunohistochemical markers, only the C4d is regarded to be a sufficiently useful marker for antibody-mediated allograft rejection according to the Banff classification. This review summarizes currently available useful immunohistochemical markers of renal transplant pathology, including C4d, with diagnostic implications for human renal allograft rejection. In particular, we discuss immunohistochemical markers in the following three categories: immunohistochemical markers of renal pathology used to (i) analyze the mechanisms of alloimmune rejection, (ii) monitor cell injury and/or inflammation associated with rejection and (iii) identify renal components in order to improve the diagnosis of rejection. In addition, recent progress in the field of renal transplant pathology includes the development of a new method for assessing molecular pathology using OMICS analyses. As the recent findings of various studies in patients undergoing renal transplantation are very encouraging, novel immunohistochemical markers must be also developed and combined with new technologies for the diagnosis of human renal allograft rejection.
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Kanzaki
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimizu
mesh_terms: D064591:Allografts; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D015935:Complement C4b / Q000032:analysis; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D018836:Inflammation Mediators / Q000032:analysis; D007518:Isoantibodies / Q000032:analysis; D007668:Kidney / Q000276:immunology* / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D010446:Peptide Fragments / Q000032:analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
keywords: Banff classification; C4d; immunohistochemical marker; renal allograft rejection; renal transplantation