Utility of C4d immunostaining in the first year after pediatric and young adult heart transplantation

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:32

Article

Galambos, Csaba¹  Reyes-Mugica, Miguel¹  Miller, Susan A.²  Zeevi, Adriana¹  Webber, Steven A.²  Feingold, Brian² 

[1] Univ Pittsburgh, Sch Med, Dept Pathol, Pittsburgh, PA USA

[2] UPMC, Childrens Hosp Pittsburgh, Div Pediat Cardiol, Pittsburgh, PA 15224 USA

关键词: pediatric;    heart transplant;    C4d;    antibody mediated rejection;    alloantibody;   

DOI  :  10.1016/j.healun.2012.10.009

来源: Elsevier

【 摘 要 】

BACKGROUND: C4d assessment of endomyocardial biopsies (EMBs) after heart transplantation (HTx) has been widely adopted to aid in the diagnosis of antibody-mediated rejection (AMR), yet it remains unclear whether or not to assess all patients routinely and with what frequency/duration. In this study we sought to evaluate the utility of routine C4d immunostaining in the first year after pediatric and young adult HTx. METHODS: We reviewed pre-transplant alloantibody and clinical data, including serial EMB reports, on all 51 patients who received HTx at our center since we instituted routine C4d staining of all first-year EMBs. C4d was considered positive if diffuse capillary staining (>= 2(+)) was present. Rare/focal capillary staining or absence of staining was considered negative. RESULTS: Twenty-six of 406 first-year EMBs (6%) were C4d(+) in 6 (12%) patients. Sixty-five percent of all C4d(+) EMBs occurred by 30 days post-transplant. Five of 6 patients had pre-transplant donor-specific antibody (DSA) >= 4,000 MFI. The sixth patient had neither pre-transplant anti-HLA antibodies nor a positive donor-specific cytotoxicity crossmatch (DSXM), but there was clinical concern for AMR. Among the entire cohort, 5 of 10 patients with pre-transplant DSA >= 4,000 MR and/or a positive DSXM were C4d(+) compared with only 1 of 41 without (50% vs 2%; p = 0.001). CONCLUSIONS: In the first year after HTx, C4d(+) occurred early and only in children and young adults with pre-transplant DSA or with clinical suspicion of AMR. Although our data suggest that assessment limited to the first 90 days post-transplant in patients with pre-transplant DSA >= 4,000 MR may be appropriate in the absence of clinical concern for AMR, further research is needed to determine the optimum strategy for post-transplant surveillance. J Heart Lung Transplant 2013;32:92-97 (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free