Pancreas allograft biopsies with positive C4d staining and anti-donor antibodies related to worse outcome for patients

H. De Kort, R. B. Munivenkatappa, S. P. Berger, M. Eikmans, A. Van Der Wal, E. J. De Koning, C. Van Kooten, E. De Heer, R. N. Barth, J. A. Bruijn, Benjamin Philosophe, C. B. Drachenberg, I. M. Bajema

Research output: Contribution to journalArticle

Abstract

C4d+ antibody-mediated rejection following pancreas transplantation has not beenwell characterized. Therefore, we assessed the outcomes of 27 pancreas transplantation patients (28 biopsies), with both C4d staining and donor-specific antibodies (DSA) determined, from a cohort of 257 patients. The median follow-up was 50 (interquartile range [IQR] 8-118) months. Patients were categorized into 3 groups: group 1, patients with minimal or no C4d staining and no DSA (n = 13); group 2, patients with either DSA present but no C4d, diffuse C4d+ and no DSA or focal C4d+ and DSA (n = 6); group 3, patients with diffuse C4d+ staining and DSA (n = 9). Active septal inflammation, acinar inflammation and acinar cell injury/necrosis were significantly more abundant in group 3 than in group 2 (respective pvalues: 0.009; 0.033; 0.025) and in group 1 (respective p-values: 0.034; 0.009; 0.002). The overall uncensored pancreas graft survival rate for groups 1, 2 and 3 were 53.3%, 66.7% and 34.6%, respectively (p = 0.044). In conclusion, recipients of pancreas transplants with no C4d or DSA had excellent long-term graft survival in comparison with patients with both C4d+ and DSA present. Hence, C4d should be used as an additional marker in combination with DSA in the evaluation of pancreas transplant biopsies.

Original languageEnglish (US)
Pages (from-to)1660-1667
Number of pages8
JournalAmerican Journal of Transplantation
Volume10
Issue number7
DOIs
StatePublished - Jul 2010
Externally publishedYes

Keywords

  • Allograft failure
  • Antibodies
  • Antibodymediated rejection
  • Classification
  • Complement C4d
  • Donor-specific antibodies
  • Histopathology
  • Humoral rejection
  • Immunohistochemistry
  • Pancreas transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)
  • Medicine(all)

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  • Cite this

    De Kort, H., Munivenkatappa, R. B., Berger, S. P., Eikmans, M., Van Der Wal, A., De Koning, E. J., Van Kooten, C., De Heer, E., Barth, R. N., Bruijn, J. A., Philosophe, B., Drachenberg, C. B., & Bajema, I. M. (2010). Pancreas allograft biopsies with positive C4d staining and anti-donor antibodies related to worse outcome for patients. American Journal of Transplantation, 10(7), 1660-1667. https://doi.org/10.1111/j.1600-6143.2010.03079.x