|Humoral heart rejection (severe allograft dysfunction with no signs of cellular rejection or ischemia): incidence, management, and the value of C4d for diagnosis.|
|PMID: 16162208 Owner: NLM Status: MEDLINE|
|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.|
|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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|Type: Journal Article; Research Support, Non-U.S. Gov't|
|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|
|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|
|Languages: eng Pagination: 2560-4 Citation Subset: IM|
|Unidad de Trasplante Cardiaco, Hospitalario Universitario Juan Canalejo, La Coruna, Spain. email@example.com|
|APA/MLA Format Download EndNote Download BibTex|
Antibody Formation / physiology*
Antigens, CD / biosynthesis
Antigens, Differentiation, Myelomonocytic / biosynthesis
Complement C1q / biosynthesis
Complement C3 / biosynthesis
Complement C4b / biosynthesis*
Fibrin / biosynthesis
Heart Transplantation / methods*
Immunoglobulin G / biosynthesis
Immunoglobulin M / biosynthesis
Myocardium / pathology*
Peptide Fragments / biosynthesis*
Steroids / therapeutic use
|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|
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