Document Detail


Humoral heart rejection (severe allograft dysfunction with no signs of cellular rejection or ischemia): incidence, management, and the value of C4d for diagnosis.
MedLine Citation:
PMID:  16162208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Severe allograft dysfunction after heart transplant (HT), without ischemia or evidence of cellular rejection upon endomyocardial biopsy (EMB), is a rare but potentially fatal condition that suggests humoral rejection (HR). Its incidence, and the methods of choice for its diagnosis and management, remain uncertain. We retrospectively studied 445 HT patients (April 1991-December 2003) to determine incidence of HR diagnosed by clinical and conventional histopathological criteria. We used immunofluorescence (IF) techniques to test archived frozen EMB issue for IgM, IgG, C1q, C3, fibrin and C4d. Twelve patients (2.7%) fulfilled the criteria for HR after a mean time post-HT of 21.3 +/- 24.7 months (range: 2-72 months). Patients were treated with high doses of steroids and plasmapheresis, with successful recovery in 11 cases. IF studies using classical markers were mainly negative for the six patients with enough EMB tissue for testing. All six patients showed positivity for C4d during the HR episode but not before or after. Humoral rejection was observed in less than 3% of HT patients. Plasmapheresis treatment was highly effective. Classical IF tests were not useful for diagnosis, but C4d appears to be useful both for confirmation of diagnosis and for monitoring response to treatment.
Authors:
Maria G Crespo-Leiro; Alberto Veiga-Barreiro; Nieves Doménech; Maria J Paniagua; Pablo Piñón; Margarita González-Cuesta; Eduardo Vázquez-Martul; Consuelo Ramirez; Jose J Cuenca; Alfonso Castro-Beiras
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons     Volume:  5     ISSN:  1600-6135     ISO Abbreviation:  Am. J. Transplant.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-15     Completed Date:  2006-01-04     Revised Date:  2007-02-14    
Medline Journal Info:
Nlm Unique ID:  100968638     Medline TA:  Am J Transplant     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  2560-4     Citation Subset:  IM    
Affiliation:
Unidad de Trasplante Cardiaco, Hospitalario Universitario Juan Canalejo, La Coruna, Spain. mcrelei@canalejo.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antibody Formation / physiology*
Antigens, CD / biosynthesis
Antigens, Differentiation, Myelomonocytic / biosynthesis
Biological Markers
Biopsy
Complement C1q / biosynthesis
Complement C3 / biosynthesis
Complement C4b / biosynthesis*
Female
Fibrin / biosynthesis
Follow-Up Studies
Graft Rejection*
Graft Survival
Heart Transplantation / methods*
Humans
Immunoglobulin G / biosynthesis
Immunoglobulin M / biosynthesis
Ischemia
Male
Microscopy, Fluorescence
Middle Aged
Myocardium / pathology*
Peptide Fragments / biosynthesis*
Plasmapheresis
Retrospective Studies
Steroids / therapeutic use
Time Factors
Transplantation, Homologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antigens, CD; 0/Antigens, Differentiation, Myelomonocytic; 0/Biological Markers; 0/CD68 antigen, human; 0/Complement C3; 0/Immunoglobulin G; 0/Immunoglobulin M; 0/Peptide Fragments; 0/Steroids; 80295-33-6/Complement C1q; 80295-50-7/Complement C4b; 80295-52-9/complement C4d; 9001-31-4/Fibrin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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