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C4d analysis in endomyocardial biopsies of heart transplant patients: is there a correlation with hemodynamic data?

Abstract：

BACKGROUND:Endomyocardial biopsy (EMB) is the gold standard for immunologic follow-up to detect acute cellular rejection after cardiac transplantation. Conversely, protocols for the diagnosis and treatment of antibody-mediated rejection (AMR) are not well defined. Histologically, AMR is diagnosed by the presence of capillary damage associated with complement activation. The aim of this study was to correlate C4d expression of activated complement in EMB with hemodynamic compromise upon right heart catheterization. METHODS:Heart transplant patients underwent hemodynamic and histologic follow-up with EMB and right heart catheterization between January 2008 and December 2009 for a total of 491 procedures. The cardiac biopsy was evaluated for acute cellular and AMR by means of the presence of the C4d complement fraction. The histologic results were compared with hemodynamic data registered during right heart catheterization. RESULTS:Comparison of the hemodynamic data of subjects with versus without C4d positivity showed no significant difference. Furthermore, there was no significant difference comparing patients with versus without C4d positivity in the absence of significant acute cellular rejection episodes. (C4d-/ACR- vs C4d+/ACR-). The variation of each single hemodynamic parameter from its basal value (defined as the mean value in case of C4d-/ACR-) seemed to not be influenced by the presence of C4d+. CONCLUSIONS:In our experience, C4d has been routinely evaluated in the majority of EMBs. We could not demonstrate a significant correlation of C4d positivity with hemodynamic compromise. These findings suggest that significant allograft dysfunction is not related to C4d positivity. Therefore, the diagnosis of AMR is difficult to establish, because allograft dysfunction is 1 of the 3 fundamental criteria.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Boffini M,Ricci D,Bonato R,Ribezzo M,Simonato E,Saviolo R,Checco L,Comoglio C,Rinaldi M

doi

10.1016/j.transproceed.2011.03.021

subject

Has Abstract

pub_date

2011-05-01 00:00:00

pages

1168-70

issue

4

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(11)00455-6

journal_volume

43

pub_type

杂志文章

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