Untitled - Roche Trasplantes

BIOPSIA DE PROTOCOLO EN EL TRASPLANTE RENAL
Figure 8. Only by electron microscopy chronic transplant capillaropathy
can be detected. At least five, better seven lamellas should
be found in the basement membrane of peritubular capillaries to
make the diagnosis.
mediated allograft injury, respectively. More than 80% of patients with chronic signs
of humoral allograft damage and specific C4d detection in peritubular capillaries have
simultaneously circulating donor-specific antibodies in their sera. In this context, a
study from the Vienna group was able to show in sequential biopsies that C4d detection
precedes the later onset of chronic transplant glomerulopathy and has herewith
a predictive value. Comparable data are available for the chronic-humoral pathogenesis
of transplant capillaropathy. These findings suggest that C4d deposition indicates
episodes of active humoral responses to the allograft and represent an early stage
of chronic irreversible allograft damage. Against this background timely detection of
C4d might allow for specific therapeutic intervention at least attenuating chronic humoral
rejection.
However, a contribution of T-cell-mediated injury to chronic rejection and the onset of
glomerulopathy, vasculopathy, or capillaropathy, beside chronic predominantly tubulointerstitial
allograft damage, might also be likely. Further studies are urgently needed
to define more precisely different entities of chronic allograft damage, which are currently
all lumped together in the non-specific term of chronic allograft nephropathy.
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