The role of C4d deposition in the diagnosis of antibody-mediated rejection after lung transplantation
| Autor: | Elbert P. Trulock, T. Mohanakumar, Ramsey R. Hachem, Chad A. Witt, Roger D. Yusen, P R Aguilar, Daniel Kreisel, D Carpenter, Derek E. Byers, Jon H. Ritter |
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| Rok vydání: | 2018 |
| Předmět: |
Graft Rejection
Male 0301 basic medicine medicine.medical_specialty Allograft failure medicine.medical_treatment 030230 surgery Article 03 medical and health sciences Postoperative Complications 0302 clinical medicine HLA Antigens Isoantibodies Risk Factors Internal medicine Complement C4b medicine Humans Immunology and Allergy Lung transplantation Pharmacology (medical) Retrospective Studies Transplantation Lung business.industry Incidence (epidemiology) Graft Survival Significant difference Middle Aged Prognosis Capillaritis medicine.disease Tissue Donors Surgery Survival Rate 030104 developmental biology medicine.anatomical_structure Cohort Antibody mediated rejection Female business Follow-Up Studies Lung Transplantation |
| Zdroj: | American Journal of Transplantation. 18:936-944 |
| ISSN: | 1600-6135 |
| Popis: | Antibody-mediated rejection (AMR) is an increasingly recognized form of lung rejection. C4d deposition has been an inconsistent finding in previous reports and its role in the diagnosis has been controversial. We conducted a retrospective single-center study to characterize cases of C4d-negative probable AMR and to compare these to cases of definite (C4d-positive) AMR. We identified 73 cases of AMR: 28 (38%) were C4d-positive and 45 (62%) were C4d-negative. The two groups had a similar clinical presentation, and although more patients in the C4d-positive group had neutrophilic capillaritis (54% vs. 29%, p = 0.035), there was no significant difference in the presence of other histologic findings. In spite of aggressive antibody-depleting therapy, 19 of 73 (26%) patients in the overall cohort died within 30 days, but there was no significant difference in freedom from chronic lung allograft dysfunction (CLAD) or survival between the two groups. We conclude that AMR may cause allograft failure, but the diagnosis requires a multidisciplinary approach and a high index of suspicion. C4d deposition does not appear to be a necessary criterion for the diagnosis, and although some cases may initially respond to therapy, there is a high incidence of CLAD and poor survival after AMR. This article is protected by copyright. All rights reserved. |
| Databáze: | OpenAIRE |
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