C4d deposition in allograft renal biopsies is an independent risk factor for graft failure

Wang, Rending; Wang, Huiping; Chen, Jianghua; Wu, Jiang; Wang, Yimin; Huang, Hongfeng; He, Qing

doi:10.1111/j.1440-1797.2009.01095.x

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…Others propose to assume a chronic antibody-mediated rejection (CAMR) even in the absence of C4d deposition in cases with peritubular capillaritis, transplant glomerulitis, thickening of the peritubular capillaries basement membrane, and circulating anti-HLA antibodies [16,17]. Detection of peritubular inflammation might be significant for indicating the subsequent poor prognosis [18,19] and thus could be regarded an early sign of graft deterioration. Our study showed a significant decrease of cortical perfusion as the inflammatory cells accumulation in peritubular capillaries increased.…”

Section: Discussionmentioning

confidence: 99%

Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys

et al. 2013

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BackgroundCortical perfusion of the renal transplant can be non-invasively assessed by color Doppler ultrasonography. We performed the Dynamic Tissue Perfusion Measurement (DTPM) of the transplant’s renal cortex using color Doppler ultrasonography (PixelFlux technique), and compared the results with the histopathological findings of transplant biopsies.MethodsNinety-six DTPM studies of the renal transplant’s cortex followed by transplant biopsies were performed in 78 patients. The cortical perfusion data were compared with the parameter of peritubular inflammatory cell accumulation (PTC 0 to 3) based on Banff-classification system.ResultsA significant decrease of cortical perfusion could be demonstrated as the inflammatory cells accumulation in peritubular capillaries increased. Increasing peritubulitis caused a perfusion loss from central to distal layers of 79% in PTC 0, of 85% in PTC 1, of 94% in PTC 2, and of 94% in PTC 3. Furthermore, the perfusion loss due to peritubular inflammation was more prominent in the distal cortical layer. The extent of perfusion decline with increasing peritubulitis (from PTC 0 to PTC 3) was 64% in proximal 20% cortical layer (p20), 63% in proximal 50% cortical layer (p50), increased to 76% in distal 50% cortical layer (d50), and peaked at 90% in the distal 20% cortical layer (d20). For those without peritubulitis (PTC 0), the increase in the the Interstitial Fibrosis/Tubular Atrophy (IF/TA) score was accompanied by a significantly increased cortical perfusion. A Polyomavirus infection was associated with an increased cortical perfusion.ConclusionsOur study demonstrated that the perfusion of the renal transplant is associated with certain pathological changes within the graft. DTPM showed a significant reduction of cortical perfusion in the transplant renal cortex related to peritubular capillary inflammation.

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Section: Discussionmentioning

confidence: 99%

Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys

et al. 2013

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“…This cytokine can be generated by many different types of circulating cells under various circumstances and is known to strongly stimulate acute phase proteins, including C‐reactive protein and complement (25, 26). Patients with complement depositions in allograft renal biopsies have an inferior graft survival (27). Furthermore, IL‐6 is known to be involved in the differentiation of antibody‐producing B‐cells (28).…”

Section: Discussionmentioning

confidence: 99%

‐174G/C interleukin‐6 gene polymorphism and the risk of transplanted kidney failure or graft loss during a 5‐year follow‐up period

Kocierz

Siekiera²,

Kolonko

et al. 2011

Tissue Antigens

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The influence of cytokine gene polymorphisms on transplanted kidney outcome is not well understood. The aim of this one-centre study was to analyse the association between tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10, interferon-γ (IFN-γ) and transforming growth factor-β1 (TGF-β1) genotypes and the incidence of delayed graft function (DGF), acute rejection (AR) and 5-year kidney graft loss. Genotyping was performed in 199 subsequent kidney graft recipients from deceased donors without induction therapy based on polymerase chain reaction method using sequence-specific primers for TNF-α (-308A/G), IL-10 (-1082A/G, -819T/C and -592A/C), IL-6 (-174G/C), IFN-γ (+874T/A) and TGF-β1 (in codons 10T/C and 25G/C). Genotypes were grouped according to the strength of cytokine expression. During a 5-year follow-up period, 14 patients died with functioning graft and 33 developed graft failure. The analysed polymorphisms were not associated with the incidence of DGF. The frequency of early episodes of AR was significantly associated only with TGF-β1 genotype. There was an association between -174G/C IL-6 gene polymorphism and the death-censored kidney graft survival. The risk of graft loss during 5-year follow-up period was greater by 57% for GG or GC (higher IL-6 production) than for CC carriers. None of the other analysed polymorphisms significantly influenced both patients and kidney graft survival, also in the analysis of the subgroup with human leucocyte antigen-DR mismatch. -174G/C IL-6 genotype of the kidney graft recipient could modulate the rate of graft excretory function deterioration and the risk of graft loss by influencing their constitutional expression.

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“…При этом даже если в морфологической картине превалируют признаки клеточного отторжения, присутствие гуморального компонента в значительной степени ухудшает прогноз нефропатии. Так, по данным различных авторов, потери трансплантата при клеточном варианте отторжения не превышают 4-7%, тогда как при его сочетании с гуморальным компонентом (С4d+) они возрастают до 30-50% [6,[14][15][16][17].…”

Section: Introductionunclassified

Late Renal Graft Rejection: Pathology and Prognosis

Столяревич¹,

Артюхина²,

Ким³

et al. 2014

RJTAO

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Отделение нефрологических проблем трансплантации почки ФГБУ «ФНЦ трансплантологии и искусственных органов им. академика В.И. Шумакова» МЗ РФ, Москва, Российская Федерация 2 Отделение патологической анатомии того же центра 3 Кафедра нефрологии факультета постдипломного образования Московского государственного медико-стоматологического университета, Москва, Российская Федерация 4 ГКБ № 52, Москва, Российская Федерация Отторжение трансплантата остается одной из наиболее частых причин дисфункции почечного трансплантата в поздние сроки после АТП. Цель исследования: проанализировать частоту встречаемости различных вариантов позднего отторжения трансплантата, выявить особенности их клинических проявлений и течения, а также определить морфологические и клинические факторы, определяющие прогноз нефропатии при различных типах позднего отторжения трансплантата. Материалы и методы. Проанализированы материалы 265 пациентов, которым в связи с поздней дисфункцией почечного трансплантата было выполнено 294 биопсии (в среднем через 48,8 ± 46,1 мес. после АТП), на основании чего верифицирован диагноз острого (n = 193) или хронического (n = 78) отторжения трансплантата либо (в 23 случаях) их сочетание. Результаты. Свечение C4d выявлялось в 36% случаев острого отторжения и в 62% случаев при ХОТ (в том числе при ХТГ-67%, при васкулопатии-50%). 5-летняя выживаемость трансплантатов составила 47, 13 и 25% при ООТ, ХОТ и сочетании ООТ+ХОТ соответственно (р < 0,01). При этом в случаях острого отторжения прогноз C4d+-форм был хуже, чем при отсутствии свечения C4d (53% vs 33%; р = 0.002), тогда как при хроническом отторжении подобная закономерность отсутствовала (36% vs 34%; p = NS). Выводы. Свечение C4d чаще выявляется при хроническом отторжении трансплантата, не влияя, однако, на его прогноз. При остром отторжении трансплантата свечение C4d отмечается реже, но является самостоятельным прогностическим фактором. Ключевые слова: трансплантация почки, гуморальное отторжение трансплантата, С4d-фрагмент системы комплемента.

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C4d deposition in allograft renal biopsies is an independent risk factor for graft failure

Abstract: Patients with C4d deposition had an inferior graft survival, especially with diffused C4d deposition, and later experienced acute rejection. C4d deposition was an independent risk factor for graft survival.

Cited by 13 publications

References 14 publications

Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys

Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys

‐174G/C interleukin‐6 gene polymorphism and the risk of transplanted kidney failure or graft loss during a 5‐year follow‐up period

Late Renal Graft Rejection: Pathology and Prognosis

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