TY - JOUR
T1 - Blood Group A antigen expression on cardiac endothelium is highly individualized
T2 - Possible implications for transplantation
AU - Gehrie, Eric A.
AU - Cates, Justin M.
AU - Nian, Hui
AU - Olson, Sandy J.
AU - Young, Pampee P.
N1 - Funding Information:
Funding: This work was supported in part by Vanderbilt University Medical Center Clinical and Translational Science Award Grant # UL1 RR024975-01 from National Center for Research Resources/National Institutes of Health (to EAG and PPY) as well as a clinical and translational enhancement award from the Vanderbilt University Medical Center Department of Pathology, Microbiology and Immunology (to EAG and PPY).
PY - 2013/7
Y1 - 2013/7
N2 - Background Outcomes in cases of adult accidental ABO incompatible cardiac transplantation are highly variable, with some patients suffering nearly immediate catastrophic antibody-mediated rejection while others (~37%-45%) survive. We hypothesize that these disparate outcomes could be influenced by variations in blood group antigen expression on allograft endothelium. Methodology Immunohistochemical stains for blood Group A antigen were performed on cardiac tissue from 18 blood Type A cadavers. Staining was evaluated by two distinct modalities: semiquantitative light microscopy, which measured the intensity of antigen expression on endothelium, and quantitative digital analysis, which determined the percentage of the total tissue section area staining positive for blood Group A antigen. These data were used to compute a Comprehensive Expression Index (CEI) of blood Group A antigen expression for each specimen. Results Semiquantitative light microscopic examination determined that endothelium was stained with low intensity in four (22%) myocardial samples, intermediate intensity in five (28%) samples, and high intensity in nine (50%) samples. Quantitative digital analysis revealed a range in the percentage of total cross sectional area composed of blood Group A-positive signal (median, 2.69%; interquartile range, 1.68%-2.94%). Increased percentage of total cross sectional area composed of blood Group A-positive signal was positively associated with patient age (P=.0037). The CEI showed a broad range, with a median of 5.27 and an interquartile range of 2.92-8.22. Conclusions There are little data available regarding interindividual differences in blood Group A antigen expression in cardiac endothelium. Here, we report interindividual variation in endothelial expression of blood Group A antigen in 18 specimens. These variations may help to explain disparate outcomes in cases of accidental ABO incompatible cardiac transplantation in adults.
AB - Background Outcomes in cases of adult accidental ABO incompatible cardiac transplantation are highly variable, with some patients suffering nearly immediate catastrophic antibody-mediated rejection while others (~37%-45%) survive. We hypothesize that these disparate outcomes could be influenced by variations in blood group antigen expression on allograft endothelium. Methodology Immunohistochemical stains for blood Group A antigen were performed on cardiac tissue from 18 blood Type A cadavers. Staining was evaluated by two distinct modalities: semiquantitative light microscopy, which measured the intensity of antigen expression on endothelium, and quantitative digital analysis, which determined the percentage of the total tissue section area staining positive for blood Group A antigen. These data were used to compute a Comprehensive Expression Index (CEI) of blood Group A antigen expression for each specimen. Results Semiquantitative light microscopic examination determined that endothelium was stained with low intensity in four (22%) myocardial samples, intermediate intensity in five (28%) samples, and high intensity in nine (50%) samples. Quantitative digital analysis revealed a range in the percentage of total cross sectional area composed of blood Group A-positive signal (median, 2.69%; interquartile range, 1.68%-2.94%). Increased percentage of total cross sectional area composed of blood Group A-positive signal was positively associated with patient age (P=.0037). The CEI showed a broad range, with a median of 5.27 and an interquartile range of 2.92-8.22. Conclusions There are little data available regarding interindividual differences in blood Group A antigen expression in cardiac endothelium. Here, we report interindividual variation in endothelial expression of blood Group A antigen in 18 specimens. These variations may help to explain disparate outcomes in cases of accidental ABO incompatible cardiac transplantation in adults.
KW - ABO incompatibility
KW - Antibody-mediated rejection
KW - Blood type incompatible transplant
KW - Cardiac transplant
KW - Immunohistochemistry
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U2 - 10.1016/j.carpath.2012.10.007
DO - 10.1016/j.carpath.2012.10.007
M3 - Article
C2 - 23290353
AN - SCOPUS:84879880849
VL - 22
SP - 251
EP - 256
JO - Cardiovascular Pathology
JF - Cardiovascular Pathology
SN - 1054-8807
IS - 4
ER -