Transpl Immunol. 2012 Dec;27(4):166-70. doi: 10.1016/j.trim.2012.08.004. Epub 2012 Aug 27.
Presence of C4d in renal and cardiac allografts is a sign of antibody-mediated rejection and is associated with worse outcomes. The value of C4d in liver specimens is controversial. We aimed to determine the association of C4d deposition with acute cellular rejection (ACR), hepatitis C (HCV) recurrence, and clinical outcome after ABO compatible liver transplants (OLT).
Using immunohistochemical stain, 70 liver biopsies (44 study and 26 control groups) were evaluated for C4d deposition. Study group included for-cause post OLT biopsies. Staining of endothelial cells was considered positive.
In the study group C4d was positive in 22.7% versus 3.8% in controls (P=0.03), all had portal vein deposits. In 17 biopsies with ACR, 3 had positive C4d (17.6%) versus 7/27 with HCV recurrence (25.9%) (P=0.4). In HCV recurrence, 3/7 biopsies with fibrosing cholestatic hepatitis had positive C4d (42.9%) versus 4/20 without these features (20%) (P=0.24). Out of 10 recipients with positive C4d 4 had poor outcomes versus 3/22 with negative C4d (P=0.12).
C4d staining was significantly more frequent in post OLT biopsies compared with controls. C4d is not specifically associated with ACR and does not differentiate it from HCV recurrence but is associated with a trend toward poorer outcome.
在肾和心脏移植物中存在 C4d 是抗体介导排斥反应的标志，与更差的结果相关。C4d 在肝标本中的价值存在争议。我们旨在确定 C4d 沉积与急性细胞排斥（ACR）、丙型肝炎（HCV）复发以及 ABO 相容肝移植（OLT）后的临床结果之间的关联。
使用免疫组织化学染色，对 70 例肝活检（44 例研究组和 26 例对照组）进行 C4d 沉积评估。研究组包括 OLT 后因原因进行的活检。将内皮细胞染色视为阳性。
在研究组中，C4d 在 22.7%的病例中呈阳性，而对照组中为 3.8%（P=0.03），所有病例均有门静脉沉积。在 17 例 ACR 活检中，3 例 C4d 阳性（17.6%），而 7/27 例 HCV 复发（25.9%）（P=0.4）。在 HCV 复发中，3/7 例具有纤维性胆汁性肝炎的活检中有 C4d 阳性（42.9%），而 4/20 例无这些特征的活检中无阳性（20%）（P=0.24）。在 10 例 C4d 阳性的受者中，4 例预后不良，而 22 例 C4d 阴性的受者中 3 例预后不良（P=0.12）。
与对照组相比，OLT 后活检中 C4d 染色明显更为频繁。C4d 与 ACR 无特异性关联，也不能将其与 HCV 复发区分开来，但与预后不良的趋势相关。
