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