de Gouveia R H, Vitorino E, Ramos S, Rebocho M J, Queirós E Melo J, Martins A P, Moura M L C
Department of Pathology, Hospital de Santa Cruz-CHLO, Lisbon, Portugal.
Transplant Proc. 2009 Apr;41(3):866-7. doi: 10.1016/j.transproceed.2009.02.002.
Acute antibody-mediated (humoral) rejection is a major cause of morbidity, graft loss, and mortality among heart transplant patients. Herein we have presented our experience using C4d to characterize humoral rejection.
All nonformalin-fixed cardiac graft biopsies (protocol or emergency) received between May 2007 and May 2008 were examined by immunofluorescence for C4d.
One hundred twelve endomyocardial biopsies from 25 transplanted patients included 20 males and 5 females of ages ranging from 3 to 71 years. The number of biopsies per subject varied from 1 to 11; the timespan between transplantation and the diagnostic biopsies ranged from days to 8 years. Thirteen biopsies showed acute humoral rejection (intramyocardial capillaries positive for C4d); 31, acute cellular rejection (grades 1R, 2R); 7, both humoral and cellular rejection; and 1, acute humoral rejection and allograft vasculopathy. Some of the positive biopsies belonged to the same person, and some to transplanted individuals with signs and symptoms suggestive of rejection, while others did not. The persistence of humoral rejection, despite the disappearance of a cellular component, correlated with slower clinicoechocardiographic improvement.
C4d positivity is a morphologic sign of humoral rejection. It may hasten the appearance and/or worsening of allograft vasculopathy independent of patient age or posttransplantation time.
急性抗体介导（体液性）排斥反应是心脏移植患者发病、移植失败及死亡的主要原因。在此，我们介绍了使用C4d来鉴定体液性排斥反应的经验。
对2007年5月至2008年5月间接收的所有非福尔马林固定的心脏移植活检标本（常规或急诊）进行C4d免疫荧光检查。
25例移植患者的112份心内膜活检标本，包括20例男性和5例女性，年龄在3至71岁之间。每位受试者的活检标本数量从1份到11份不等；移植与诊断性活检之间的时间跨度从数天至8年。13份活检标本显示急性体液性排斥反应（心肌内毛细血管C4d阳性）；31份显示急性细胞性排斥反应（1R级、2R级）；7份显示体液性和细胞性排斥反应均存在；1份显示急性体液性排斥反应和移植血管病。部分阳性活检标本来自同一患者，部分来自有排斥反应体征和症状的移植个体，还有一些则没有。尽管细胞成分消失，但体液性排斥反应的持续存在与临床超声心动图改善较慢相关。
C4d阳性是体液性排斥反应的形态学标志。它可能会加速移植血管病的出现和/或恶化，与患者年龄或移植后时间无关。
