title: Lack of Impact of Presence of Positive C4d Staining in Capillaries in Myocardial Biopsies on Long-term Survival of Heart Transplant Patients.
abstract: BACKGROUND
  The long-term survival of 209 consecutive patients (mean age, 46 ± 15 years) from a single center with ≥1 diagnostic myocardial biopsy after heart transplantation was analyzed.
  
  
  METHODS
  Patients were considered as C4d positive if a capillary staining (immunohistochemistry in paraffin samples) was observed in ≥1 myocardial biopsy. Data were analyzed according to pathologic consensus of antibody mediated rejection definition of C4d+ positivity: 2004 definition in group A and the 2013 definition in group B and compared with their respective controls, composed of patients who do not meet those criteria. Age, follow-up time, and number of biopsies were comparable between patients with C4d+ and controls in both groups. Follow-up was 100% complete with mean of observation time 2143 days.
  
  
  RESULTS
  During the follow-up period, 62 patients died (group A: C4d+ 32% vs controls 29%; group B: C4d+ 36% vs controls 29% [P = NS]). There were no differences in survival between patients with positive staining and without C4d+ staining when Kaplan-Meier survival curves were compared.
  
  
  CONCLUSIONS
  The presence of C4d positive staining in myocardial capillaries of heart biopsies of patients after heart transplantation, as an isolated finding, was not related to worse long-term survival.
authors: Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland. Electronic address: tzielinski@ikard.pl.
authors: T
authors: T
authors: Zieliński
authors: Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: M
authors: M
authors: Sobieszczańska-Małek
authors: Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: M
authors: M
authors: Karczmarz
authors: Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: K
authors: K
authors: Komuda
authors: Department of Pathology, The Children's Memorial Health Hospital, Warsaw, Poland.
authors: W
authors: W
authors: Grajkowska
authors: Department of Pathology, The Children's Memorial Health Hospital, Warsaw, Poland.
authors: M
authors: M
authors: Pronicki
authors: Department of Pathology, The Children's Memorial Health Hospital, Warsaw, Poland.
authors: S
authors: S
authors: Szymańska
authors: Department of Pathology, The Children's Memorial Health Hospital, Warsaw, Poland.
authors: P
authors: P
authors: Kluge
authors: Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: A
authors: A
authors: Browarek
authors: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors: P
authors: P
authors: Bekta
authors: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors: M
authors: M
authors: Karcz
authors: Department of Cardiosurgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: A
authors: A
authors: Parulski
authors: Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors: A
authors: A
authors: Wójcik
authors: Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors: A
authors: A
authors: Klisiewicz
authors: Department of Cardiosurgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: M
authors: M
authors: Kuśmierczyk
authors: Department of Cardiosurgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: J
authors: J
authors: Różański
authors: Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors: J
authors: J
authors: Korewicki
mesh_terms: D001706:Biopsy; D002196:Capillaries / Q000378:metabolism*; D015935:Complement C4b / Q000378:metabolism*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D012189:Retrospective Studies; D013194:Staining and Labeling / Q000379:methods
chemical_list: D015935:Complement C4b