Namba Yukiomi, Oka Kazumasa, Moriyama Toshiki, Kyo Masahiro, Imamura Ryoichi, Shi Yi, Ichimaru Naotsugu, Isaka Yoshitaka, Takahara Shiro, Okuyama Akihiko
Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan.
Clin Transplant. 2006;20 Suppl 15:20-5. doi: 10.1111/j.1399-0012.2006.00545.x.
The incidence of positive C4d deposition in peritubular capillaries (PTC) in long-term survival cases remains controversial. Some incidences of positive C4d deposition in PTC in cases of long-term survival less than 10 yr have been reported. We retrospectively examined the incidence of positive C4d deposition in long-term survival cases over 10 yr after renal transplantation and the histological and clinical characteristics of the positive C4d staining cases.
We examined 14 protocol biopsy cases performed at Osaka University Hospital between March 2004 and March 2005. The average interval between the operation and the day of biopsy was 15.4 yr. Histological diagnosis was made in accordance with the Banff 97 classification. Paraffin-embedded tissue was stained with polyclonal anti-C4d antibody. Detection of donor-specific antibody (DSA) was determined by flow cytometric assay. The cases were divided according to C4d positivity.
Three of 14 cases (21.4%) were C4d positive and belonged to the C4d+/DSA+ group, while 11 cases were of the C4d-/DSA- group. There were no significant differences between the two groups in serum creatinine (sCr) or proteinuria at the time of biopsy. A trend towards decreasing rate of the inverse of sCr (1/sCr) in the C4d+/DSA+ group was noted. In the C4d+/DSA+ group, three transplant glomerulopathy (TGP) were identified. On the other hand, TGP were identified in six of 11 cases of the C4d-/DSA- group. We investigated the relevance of typical chronic rejection (CR) features and the positivity of C4d. No significant differences were observed between the CR features and C4d depositions in PTC (p = 0.26).
In long-term survival cases with positive C4d, a trend towards decreasing rate of 1/sCr was revealed, but their histological characteristic features was not recognized.
长期存活病例中，肾小管周毛细血管（PTC）C4d沉积阳性的发生率仍存在争议。有报道称长期存活不足10年的病例中存在PTC C4d沉积阳性的情况。我们回顾性研究了肾移植术后10年以上长期存活病例中C4d沉积阳性的发生率以及C4d染色阳性病例的组织学和临床特征。
我们检查了2004年3月至2005年3月在大阪大学医院进行的14例方案活检病例。手术与活检日之间的平均间隔为15.4年。组织学诊断依据Banff 97分类标准。石蜡包埋组织用多克隆抗C4d抗体染色。通过流式细胞术检测供体特异性抗体（DSA）。根据C4d阳性情况对病例进行分组。
14例病例中有3例（21.4%）C4d阳性，属于C4d+/DSA+组，而11例属于C4d-/DSA-组。两组在活检时的血清肌酐（sCr）或蛋白尿方面无显著差异。注意到C4d+/DSA+组中sCr倒数（1/sCr）的下降率有降低趋势。在C4d+/DSA+组中，发现3例移植肾小球病（TGP）。另一方面，C4d-/DSA-组的11例病例中有6例发现TGP。我们研究了典型慢性排斥反应（CR）特征与C4d阳性之间的相关性。在PTC中的CR特征与C4d沉积之间未观察到显著差异（p = 0.26）。
在C4d阳性的长期存活病例中，显示出1/sCr下降率的趋势，但未识别出其组织学特征。
