Coincidence of cellular and antibody mediated rejection in heart transplant recipients - preliminary report
Coincidence of cellular and antibody mediated rejection in heart transplant recipients - preliminary report
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DOI：
10.5114/kitp.2014.41932
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发表时间：
2014-01-01
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通讯作者：
Zembala, Marian
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作者：
Zakliczynski, Michal;Nozynski, Jerzy;Zembala, Marian
抗体介导的排斥反应(AMR)对原位心脏移植(OHT)的效果有重要影响。然而，AMR和细胞排斥(CR)共存的描述很少。因此，我们开展了一项前瞻性先导性研究，以评估27例OHT受者(21例男性/6例女性，45.4+/-14.4y/o)心内膜心肌活检(EMBS)中AMR/CR伴发情况。活检样本石蜡包埋，通常用苏木精/伊红染色来评估CR，如果有足够数量的材料，用免疫组织化学方法定位C3d和C4d颗粒作为抗体依赖补体激活的标志。通过这种方法，80个eMbs，其中41个(51%)在OHT后第一个月内收获，符合研究条件。其中C3d+14例(18%)，C4d+37例(46%)，C3d+C4d同时阳性12例(15%)。C3d+10例(37%)，C4d+17例(63%)，C3d/C4d+EMB 8例(30%)。37例CR0 eMBS中，C3d 4例(11%)，C4d 17例(46%)，C3d/C4d均为3例(8%)。28例CR1 eMBS中，C3d 3例(11%)，C4d 11例(39%)，C3d/C4d 3例(11%)。15例CR2 eMBS中，C3d 7例(47%)，C4d 9例(60%)，C3d/C4d 6例(40%)。CR0-1eMBS组与CR2eMBS组C3d和C3d/C4d发生率分别为7/65~11%和6/65~9%，与CR2组比较差异有统计学意义(P=0.0035和P=0.0091)。综上所述，这一初步研究中显示的明显频繁的CR和AMR共存值得在该领域进行进一步的研究。
Antibody mediated rejection (AMR) can significantly influence the results of orthotopic heart transplantation (OHT). However, AMR and cellular rejection (CR) coexistence is poorly described. Therefore we performed a prospective pilot study to assess AMR/CR concomitance in endomyocardial biopsies (EMBs) obtained electively in 27 OHT recipients (21 M/6 F, 45.4 +/- 14.4 y/o). Biopsy samples were paraffin embedded and processed typically with hematoxylin/eosin staining to assess CR, and, if a sufficient amount of material remained, treated with immunohistochemical methods to localize particles C3d and C4d as markers of antibody dependent complement activation. With this approach 80 EMBs, including 41 (51%) harvested within the first month after OHT, were qualified for the study. Among them 14 (18%) were C3d+, 37 (46%) were C4d+, and 12 (15%) were both C3d and C4d positive. At least one C3d+, C4d+, and C3d/C4d+ EMB was found in 10 (37%), 17 (63%), and 8 (30%) patients, respectively. Among 37 CR0 EMBs C3d was observed in 4 (11%), C4d in 17 (46%), and both C3d/C4d in 3 (8%) cases. Among 28 CR1 EMBs C3d was observed in 3 (11%), C4d in 11 (39%), and C3d/C4d in 3 (11%) cases. Among 15 CR2 EMBs C3d was observed in 7 (47%), C4d in 9 (60%), and C3d/C4d in 6 (40%) cases. Differences in C3d and C3d/C4d occurrence between grouped CR0-1 EMBs and CR2 EMBs (7/65 - 11% vs. 7/15 - 47%; 6/65 - 9% vs. 6/15 - 40%) were significant (p = 0.0035 and p = 0.0091, respectively,chi(2) test). In conclusion, apparently frequent CR and AMR coexistence demonstrated in this preliminary study warrants further investigation in this field.