Morphologic and immunophenotypic evaluation of liver allograft biopsies with contemporaneous serum DSA measurements

Hag, Mohamed El; Kaneku, Hugo; Jorgensen, Dana; Zeevi, Adriana; Stevenson, Heather L.; Yadak, Nour; Hassan, Mohamed; Du, Xiaotang; Demetris, Anthony J.

doi:10.1111/ctr.14997

Cited by 2 publications

(1 citation statement)

References 53 publications

(105 reference statements)

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“…Antibody-mediated rejection is highly detrimental to the prolonged survival of transplanted kidneys. However, C4d has a much wider application in transplantology, specifically in the detection of antibody-mediated rejection of other diverse organ allografts, including the heart (5), pancreas (6), liver (7), small intestine (8), lungs (9) or more recently, in face tissue allografts (10). Immunohistochemical staining for complement components, including C4d, in different transplant organ biopsies may be useful in understanding how complement is activated in individual cases.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic significance of C4d deposits, as an immunohistochemical proof of complement activation, in kidney glomerular pathologies and kidney transplantation

HRESKO,

MADAROVA,

DOBOSOVA

et al. 2024

BLL

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C4d, a split product of C4 activation in classical and lectin pathways of the complement system activation, has been regarded as a footprint of tissue damage in antibody-mediated rejection in transplantology. The introduction of C4d staining into daily clinical practice aroused an ever-increasing interest in the role of antibody-mediated mechanisms in kidney allograft rejection. However, this marker of complement activation is also important in other various kidney glomerular pathologies such as immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, lupus nephritis, and others. In routine histopathological practice, C4d staining can be done by two histological methods, specifically by immunofluorescence on frozen tissue using monoclonal antibody to C4d (with the downside of unsteady availability of frozen tissue) or by immunohistochemistry using C4d antibodies on formalin-fixed and paraffin-embedded renal tissue. The aim of this narrative review is to summarize recent knowledge about the complement fragment C4d and its significance in different kidney pathologies, focusing on its immunohistochemical detection in renal tissue biopsies. We have supplemented this review with our experience with our proprietary methodology of preparation and practical use of antibodies such as anti-C4d, on a small national level. Immunohistochemical staining for C4d has revolutionized the field of renal histopathology. Despite being a simple diagnostic test, its utility can be of utmost importance, especially in a resource-poor setting where immunofluorescence and frozen tissue may not be available (Fig. 2, Ref. 53).

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Section: Introductionmentioning

confidence: 99%

The diagnostic significance of C4d deposits, as an immunohistochemical proof of complement activation, in kidney glomerular pathologies and kidney transplantation

HRESKO,

MADAROVA,

DOBOSOVA

et al. 2024

BLL

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Antibody-Mediated Rejection in Liver Transplantation: Immuno-Pathological Characteristics and Long-Term Follow-Up

Cicalese,

Walton,

et al. 2024

Transpl Int

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The diagnosis of liver antibody-mediated rejection (AMR) is challenging and likely under-recognized. The association of AMR with donor-specific antibodies (DSA), and its clinical course in relation to pathologic findings and treatment are ill defined. We identified cases of liver AMR by following the criteria outlined by the 2016 Banff Working Group. Patient demographics, native liver disease, histopathologic findings, treatment type, clinical outcome, and transaminase levels during AMR diagnosis, treatment, and resolution were determined. Patients (n = 8) with AMR average age was 55.2 years (range: 19–68). Seven of eight cases met the Banff criteria for AMR. Personalized treatment regimens consisted of optimization of immunosuppression, intravenous pulse steroids, plasmapheresis, IVIG, rituximab, and bortezomib. Five patients experienced complete resolution of AMR, return of transaminases to baseline, and decreased DSA at long-term follow-up. One patient developed chronic AMR and two patients required re-transplantation. Follow-up after AMR diagnosis ranged from one to 11 years. Because AMR can present at any time, crossmatch, early biopsy, and routine monitoring of DSA levels should be implemented following transaminase elevation to recognize AMR. Furthermore, treatment should be immediately implemented to reverse AMR and prevent graft failure, chronic damage, re-transplantation, and possibly mortality.

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Morphologic and immunophenotypic evaluation of liver allograft biopsies with contemporaneous serum DSA measurements

Cited by 2 publications

References 53 publications

The diagnostic significance of C4d deposits, as an immunohistochemical proof of complement activation, in kidney glomerular pathologies and kidney transplantation

The diagnostic significance of C4d deposits, as an immunohistochemical proof of complement activation, in kidney glomerular pathologies and kidney transplantation

Antibody-Mediated Rejection in Liver Transplantation: Immuno-Pathological Characteristics and Long-Term Follow-Up

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