BACKGROUND: The aim of this study was to assess the significance of positive C4d capillary immunostaining of endomyocardial biopsies and its correlation to clinical outcome in adult heart transplant recipients. METHODS: Nine hundred eighty-five endomyocardial biopsies from 107 heart transplant recipients were evaluated. Immunostaining for detection of intragraft C4d capillary deposition was performed on paraffin-embedded tissue using anti-human C4d polyclonal antibody. RESULTS: Positive staining of C4d was present in 36 patients (34%) and antibody-mediated rejection in eight patients (7%). The patients were subdivided into four groups on the basis of their C4d, circulating antidonor antibodies (donor-specific antibodies [DSAs]), and graft function: group 1=C4d positive, DSA negative, and no graft dysfunction; group 2=C4d positive, DSA positive, and no graft dysfunction; group 3=C4d positive, DSA positive, and signs of graft dysfunction, and group 0 (control)=all negative. An higher mortality risk was found in C4d-positive patients, when compared with negative ones (unadjusted hazard ratios: group 1: 18, group 2: 61, and group 3: 32-fold risk; P<0.0001). CONCLUSIONS: Antibody-mediated rejection is a complex and ongoing phenomenon with different phenotypic features. C4d positive predicts worse prognosis. C4d positive [corrected] and DSA can be used as early mortality predictors in patients without signs of graft dysfunction.
BACKGROUND: The aim of this study was to assess the significance of positive C4d capillary immunostaining of endomyocardial biopsies and its correlation to clinical outcome in adult heart transplant recipients. METHODS: Nine hundred eighty-five endomyocardial biopsies from 107 heart transplant recipients were evaluated. Immunostaining for detection of intragraft C4d capillary deposition was performed on paraffin-embedded tissue using anti-human C4d polyclonal antibody. RESULTS: Positive staining of C4d was present in 36 patients (34%) and antibody-mediated rejection in eight patients (7%). The patients were subdivided into four groups on the basis of their C4d, circulating antidonor antibodies (donor-specific antibodies [DSAs]), and graft function: group 1=C4d positive, DSA negative, and no graft dysfunction; group 2=C4d positive, DSA positive, and no graft dysfunction; group 3=C4d positive, DSA positive, and signs of graft dysfunction, and group 0 (control)=all negative. An higher mortality risk was found in C4d-positive patients, when compared with negative ones (unadjusted hazard ratios: group 1: 18, group 2: 61, and group 3: 32-fold risk; P<0.0001). CONCLUSIONS: Antibody-mediated rejection is a complex and ongoing phenomenon with different phenotypic features. C4d positive predicts worse prognosis. C4d positive [corrected] and DSA can be used as early mortality predictors in patients without signs of graft dysfunction.
Authors: Danielle Cohen; Robert B Colvin; Mohamed R Daha; Cinthia B Drachenberg; Mark Haas; Volker Nickeleit; Jane E Salmon; Banu Sis; Ming-Hui Zhao; Jan A Bruijn; Ingeborg M Bajema Journal: Kidney Int Date: 2012-02-01 Impact factor: 10.612
Authors: Jon Kobashigawa; Maria G Crespo-Leiro; Stephan M Ensminger; Hermann Reichenspurner; Annalisa Angelini; Gerald Berry; Margaret Burke; Lawrence Czer; Nicola Hiemann; Abdallah G Kfoury; Donna Mancini; Paul Mohacsi; Jignesh Patel; Naveen Pereira; Jeffrey L Platt; Elaine F Reed; Nancy Reinsmoen; E Rene Rodriguez; Marlene L Rose; Stuart D Russell; Randy Starling; Nicole Suciu-Foca; Jose Tallaj; David O Taylor; Adrian Van Bakel; Lori West; Adriana Zeevi; Andreas Zuckermann Journal: J Heart Lung Transplant Date: 2011-03 Impact factor: 10.247
Authors: Benjamin L Laskin; Julia Maisel; Jens Goebel; Hong J Yin; Guangju Luo; Jane C Khoury; Stella M Davies; Sonata Jodele Journal: Transplantation Date: 2013-07-27 Impact factor: 4.939
Authors: Ying Xu; Csaba Galambos; Miguel Reyes-Múgica; Susan A Miller; Adriana Zeevi; Steven A Webber; Brian Feingold Journal: J Heart Lung Transplant Date: 2013-01 Impact factor: 10.247