Immunohistochemistry staining of C4d to diagnose anti body-mediated rejection in cardiac transplantation
Immunohistochemistry staining of C4d to diagnose anti body-mediated rejection in cardiac transplantation
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DOI：
10.1016/j.healun.2008.01.003
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发表时间：
2008-04-01
影响因子：
8.9
通讯作者：
Husain, Aliya N.
中科院分区：
文献类型：
--
作者：
Fedson, Savitri E.;Daniel, Silver S.;Husain, Aliya N.
背景：抗体介导的排斥反应（AMR）与心脏移植的不良结局相关。AMR的临床诊断已通过新鲜冷冻心脏组织上C4d的免疫荧光证实。免疫组织化学（IHC）已被建议作为一个更实用的诊断工具，因为它可以在常规石蜡包埋组织上进行。关于血流动力学和C4d染色的报道很少。我们前瞻性地进行C4d染色的子宫内膜异位症活检（EMBs）和目前的组织染色模式及其与intracardiac血流动力学的相关性。方法：EMBs进行了评估，通过免疫组化C4d染色和分级的细胞排斥反应，使用ISHLT标准的苏木精和伊红染色的部分。同时进行血液动力学测量。C4d染色描述为不存在、存在血清染色或仅存在组织染色。组织染色模式按染色位置分类，并与心内血流动力学相关。患者的人口统计学资料，巨细胞病毒状态，面板反应性抗体水平和血流动力学进行了分析，方差分析和卡方statistics.Results：400 EMBs，50没有C4d染色，330有组织和血清染色，而20只有组织染色。40个EMB有内皮染色，包括35个血清染色和5个分离组织染色。结论：C4d免疫组化染色可用于AMR的诊断。我们的数据表明，背景C4d染色率很高，但内皮染色与血流动力学较差相关。免疫组化染色和解释的方法需要标准化，以广泛使用和临床研究。
Background: Antibody-mediated rejection (AMR) is associated with poorer outcomes in cardiac transplantation. The clinical diagnosis of AMR has been confirmed by immunofluorescence for C4d on fresh-frozen cardiac tissue. Immunohistochemistry (IHC) has been suggested as a more practical diagnostic tool because it can be performed on routine paraffin-embedded tissue. There are few published data about hemodynamics and C4d staining. We prospectively performed C4d staining on endomyocardial biopsies (EMBs) and present the pattern of tissue staining and its correlation with intracardiac hemodynamics.Methods: EMBs were evaluated by IHC for C4d staining and graded for cellular rejection using ISHLT criteria on hematoxylin-and-eosin-stained sections. Hemodynamic measurements were taken concurrently. Staining for C4d was described as absent, present with serum staining, or present with only tissue staining. The pattern of tissue staining was categorized by location of staining and correlated with intracardiac hemodynamics. Patient demographics, cytomegalovirus status, panel-reactive antibody levels and hemodynamics were analyzed by analysis of variance and chi-square statistics.Results: Of the 400 EMBs, 50 had no C4d staining, 330 had tissue and serum staining, whereas 20 had only tissue staining. Forty EMBs had endothelial staining, including 35 with serum and 5 with isolated tissue staining. Endothelial staining correlated with higher intracardiac pressures.Conclusions: IHC staining for C4d has been suggested for the diagnosis of AMR. Our data suggest there is a high rate of background C4d staining, but endothelial staining correlates with poorer hemodynamics. Methods for IHC staining and interpretation need to be standardized for widespread use and clinical studies.