Cheunsuchon B, Vongwiwatana A, Premasathian N, Shayakul C, Parichatikanond P
Department of Pathology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2009 Nov;41(9):3697-700. doi: 10.1016/j.transproceed.2009.04.015.
Antibody-mediated rejection (AMR) has been recognized recently as an important cause of graft failure. Detection of C4d in renal allograft biopsies is a proven ancillary technique in the diagnosis of AMR. The prevalence of C4d staining in Western countries varies from 17% to 60% among indication biopsies. There are only a few C4d prevalence studies in an Asian population. The objective of this study was to identify prevalence of C4d among Thai renal transplant patients. Consecutive renal allograft biopsies from 99 patients from 1999 to 2007 were stained for C4d by an immunoperoxidase technique. The biopsy slides were evaluated for the diagnosis according to the Banff'07 classification and histological scores. The relevant clinical data were obtained from clinical records. The prevalence of C4d in renal allografts was reported as a percentage using a descriptive analysis. Chi-square and unpaired Student t tests were used to evaluate the association between clinicopathologic findings and C4d positivity. P values less than .05 were considered significant. The prevalence of positive C4d staining was 16.4%. Fourteen biopsies (10.4%) showed diffuse staining while 8 (5.9%) revealed focal staining. Transplant glomerulopathy, glomerulitis, and peritubular capillaritis were associated with C4d positivity. Most inflammatory cells in peritubular capillaritis were mononuclear cells. Banff score elements, including tubulitis, intimal arteritis, interstitial infiltrate, interstitial fibrosis, tubular atrophy, mesangial matrix increase, vascular fibrous thickening, and arteriolar hyaline thickening, were not associated with C4d positivity. Many factors contribute to the varied prevalence of C4d positivity, including immunologic risks for AMR, type of allograft biopsy, and technique of C4d staining. Our study showed no difference in C4d prevalence among Thai renal allograft patients compared to the Western population. The suggestion to use C4d staining on all allograft biopsies should applied to Thai patients as well.
抗体介导的排斥反应（AMR）近来已被公认为是移植物功能衰竭的一个重要原因。检测肾移植活检组织中的C4d是诊断AMR的一项已得到验证的辅助技术。在西方国家，指征性活检中C4d染色的发生率在17%至60%之间。在亚洲人群中仅有少数关于C4d发生率的研究。本研究的目的是确定泰国肾移植患者中C4d的发生率。对1999年至2007年99例患者的连续肾移植活检组织采用免疫过氧化物酶技术进行C4d染色。根据Banff'07分类和组织学评分对活检玻片进行诊断评估。相关临床数据从临床记录中获取。肾移植中C4d的发生率采用描述性分析以百分比形式报告。采用卡方检验和非配对学生t检验评估临床病理表现与C4d阳性之间的相关性。P值小于0.05被认为具有统计学意义。C4d染色阳性的发生率为16.4%。14例活检组织（10.4%）显示弥漫性染色，而8例（5.9%）显示局灶性染色。移植性肾小球病、肾小球炎和肾小管周围毛细血管炎与C4d阳性相关。肾小管周围毛细血管炎中的大多数炎症细胞为单核细胞。Banff评分要素，包括肾小管炎、内膜动脉炎、间质浸润、间质纤维化、肾小管萎缩、系膜基质增加、血管纤维增厚和小动脉玻璃样增厚，与C4d阳性无关。多种因素导致C4d阳性的发生率各异，包括AMR的免疫风险、移植活检类型以及C4d染色技术。我们的研究表明，泰国肾移植患者中C4d的发生率与西方人群相比无差异。对所有移植活检组织进行C4d染色的建议也应适用于泰国患者。
