Corrêa Rosana Rosa Miranda, Machado Juliana Reis, da Silva Marcos Vinícius, Helmo Fernanda Rodrigues, Guimarães Camila Souza Oliveira, Rocha Laura Penna, Faleiros Ana Carolina Guimarães, dos Reis Marlene Antônia
Discipline of General Pathology, Nephropathology Service, Federal University of Triângulo Mineiro, Frei Paulino, 30, 38025-180 Uberaba, Brazil.
Clin Dev Immunol. 2013;2013:678180. doi: 10.1155/2013/678180. Epub 2013 Jul 9.
Antibody-mediated rejection (AMR) is highly detrimental to the prolonged survival of transplanted kidneys. C4d has been regarded as a footprint of AMR tissue damage, and the introduction of C4d staining in daily clinical practice aroused an ever-increasing interest in the role of antibody-mediated mechanisms in allograft rejection. Despite the general acceptance of the usefulness of C4d in the identification of acute AMR, the data for C4d staining in chronic AMR is variable. The presence of C4d in the majority of the biopsies with features of chronic antibody-mediated rejection is reported, but this rejection without C4d staining is observed as well, suggesting that C4d is specific but not sensitive. Further studies on AMR with positive C4d staining in biopsy specimens are really important, as well as the study of novel routine markers that may participate in the pathogenesis of this process.
抗体介导的排斥反应（AMR）对移植肾的长期存活极为不利。C4d被视为AMR组织损伤的标志，而日常临床实践中引入C4d染色引发了人们对抗体介导机制在同种异体移植排斥反应中作用的日益浓厚兴趣。尽管人们普遍认可C4d在识别急性AMR方面的有用性，但慢性AMR中C4d染色的数据却不尽相同。有报道称，大多数具有慢性抗体介导排斥反应特征的活检标本中存在C4d，但也观察到了无C4d染色的这种排斥反应，这表明C4d具有特异性但不敏感。对活检标本中C4d染色阳性的AMR进行进一步研究以及对可能参与该过程发病机制的新型常规标志物进行研究都非常重要。
