Untitled - Roche Trasplantes

PROTOCOL BIOPSIES AND THE DIAGNOSIS OF HUMORAL REJECTION
Figure 2. Acute glomerulitis in humoral rejection. Numerous inflammatory
cells, mainly macrophages can be found in glomerular capillaries.
Based on results from the above mentioned multicenter study we apply the following
cut-offs for C4d in our center: 50% of ptc
with specific C4d stain = diffuse C4d positive. Focal as well a diffuse C4d detection in
ptc correlated significantly with the pathological features of AHR. However, the proof that
a focal Cd4 detection is also significantly related to the presence of donor-specific antibodies
in the patient’s serum is currently lacking but was shown for diffusely positive
biopsies in several studies.
In summary, every pathological report should comprise the result of a C4d stain and describe
any morphological features potentially being part of the spectrum of humoral allograft
injury. In the bottom line or at least in the commentary of the report it should be
stated whether both, C4d detection and AHR pathology are present and with this biopsy
an episode of acute humoral rejection is diagnosed. If just one of the two features is
present (C4d or pathology) the biopsy has to be considered as being “suspicious for”
acute humoral rejection. In any case, C4d detection should always lead to the analysis of
55