Current problems of chronic active antibody-mediated rejection

Asami Takeda, Keiji Horike, Yasuhiro Ohtsuka, Daijo Inaguma, Norihiko Goto, Yoshihiko Watarai, Kazuharu Uchida, Kunio Morozumi

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

The Banff 2007 classification allows chronic rejection to be differentiated based on clinicopathological characteristics evidenced by two independent immunologic mechanisms; chronic active antibody-mediated rejection and chronic active T-lymphocyte mediated rejection. However, several incompletely understood issues concerning chronic active antibody-mediated rejection remain. Chronic active antibody-mediated rejection is characterized by C4d deposition in the capillary basement membrane(PTC), the presence of circulating anti-donor antibodies(DSA), and morphologic evidence of chronic tissue injury such as glomerular double contours compatible with transplant glomerulopathy (TPG), PTC basement membrane multilayering, interstitial fibrosis/tubular atrophy, and fibrous arterial intimal thickening. PTC basement membrane multilayering correlates highly with TPG, and most of TPG have evidence of either C4d-positive staining or DSA. However, the proposed criteria do not apply to all situations of chronic active antibody-mediated rejection. C4d is not a magic marker for antibody-mediated rejection. C4d staining is not always highly sensitive for detecting antibody-mediated rejection. Multi-institutional studies should be conducted to better understand the clinicopathological context of chronic antibody-mediated rejection. These studies should include well-designed serial protocol biopsies with evaluation by electron microscopy, C4d staining performed on frozen sections, and assessment using sensitive DSA detection methods.

Original languageEnglish
Pages (from-to)2-5
Number of pages4
JournalClinical Transplantation
Volume25
Issue numberSUPPL. 23
DOIs
Publication statusPublished - 01-07-2011
Externally publishedYes

Fingerprint

Antibodies
Factor IX
Basement Membrane
Staining and Labeling
Transplants
Tunica Intima
Magic
Frozen Sections
Atrophy
Anti-Idiotypic Antibodies
Electron Microscopy
Fibrosis
T-Lymphocytes
Biopsy
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Takeda, A., Horike, K., Ohtsuka, Y., Inaguma, D., Goto, N., Watarai, Y., ... Morozumi, K. (2011). Current problems of chronic active antibody-mediated rejection. Clinical Transplantation, 25(SUPPL. 23), 2-5. https://doi.org/10.1111/j.1399-0012.2011.01451.x
Takeda, Asami ; Horike, Keiji ; Ohtsuka, Yasuhiro ; Inaguma, Daijo ; Goto, Norihiko ; Watarai, Yoshihiko ; Uchida, Kazuharu ; Morozumi, Kunio. / Current problems of chronic active antibody-mediated rejection. In: Clinical Transplantation. 2011 ; Vol. 25, No. SUPPL. 23. pp. 2-5.
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Takeda, A, Horike, K, Ohtsuka, Y, Inaguma, D, Goto, N, Watarai, Y, Uchida, K & Morozumi, K 2011, 'Current problems of chronic active antibody-mediated rejection', Clinical Transplantation, vol. 25, no. SUPPL. 23, pp. 2-5. https://doi.org/10.1111/j.1399-0012.2011.01451.x

Current problems of chronic active antibody-mediated rejection. / Takeda, Asami; Horike, Keiji; Ohtsuka, Yasuhiro; Inaguma, Daijo; Goto, Norihiko; Watarai, Yoshihiko; Uchida, Kazuharu; Morozumi, Kunio.

In: Clinical Transplantation, Vol. 25, No. SUPPL. 23, 01.07.2011, p. 2-5.

Research output: Contribution to journalReview article

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T1 - Current problems of chronic active antibody-mediated rejection

AU - Takeda, Asami

AU - Horike, Keiji

AU - Ohtsuka, Yasuhiro

AU - Inaguma, Daijo

AU - Goto, Norihiko

AU - Watarai, Yoshihiko

AU - Uchida, Kazuharu

AU - Morozumi, Kunio

PY - 2011/7/1

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N2 - The Banff 2007 classification allows chronic rejection to be differentiated based on clinicopathological characteristics evidenced by two independent immunologic mechanisms; chronic active antibody-mediated rejection and chronic active T-lymphocyte mediated rejection. However, several incompletely understood issues concerning chronic active antibody-mediated rejection remain. Chronic active antibody-mediated rejection is characterized by C4d deposition in the capillary basement membrane(PTC), the presence of circulating anti-donor antibodies(DSA), and morphologic evidence of chronic tissue injury such as glomerular double contours compatible with transplant glomerulopathy (TPG), PTC basement membrane multilayering, interstitial fibrosis/tubular atrophy, and fibrous arterial intimal thickening. PTC basement membrane multilayering correlates highly with TPG, and most of TPG have evidence of either C4d-positive staining or DSA. However, the proposed criteria do not apply to all situations of chronic active antibody-mediated rejection. C4d is not a magic marker for antibody-mediated rejection. C4d staining is not always highly sensitive for detecting antibody-mediated rejection. Multi-institutional studies should be conducted to better understand the clinicopathological context of chronic antibody-mediated rejection. These studies should include well-designed serial protocol biopsies with evaluation by electron microscopy, C4d staining performed on frozen sections, and assessment using sensitive DSA detection methods.

AB - The Banff 2007 classification allows chronic rejection to be differentiated based on clinicopathological characteristics evidenced by two independent immunologic mechanisms; chronic active antibody-mediated rejection and chronic active T-lymphocyte mediated rejection. However, several incompletely understood issues concerning chronic active antibody-mediated rejection remain. Chronic active antibody-mediated rejection is characterized by C4d deposition in the capillary basement membrane(PTC), the presence of circulating anti-donor antibodies(DSA), and morphologic evidence of chronic tissue injury such as glomerular double contours compatible with transplant glomerulopathy (TPG), PTC basement membrane multilayering, interstitial fibrosis/tubular atrophy, and fibrous arterial intimal thickening. PTC basement membrane multilayering correlates highly with TPG, and most of TPG have evidence of either C4d-positive staining or DSA. However, the proposed criteria do not apply to all situations of chronic active antibody-mediated rejection. C4d is not a magic marker for antibody-mediated rejection. C4d staining is not always highly sensitive for detecting antibody-mediated rejection. Multi-institutional studies should be conducted to better understand the clinicopathological context of chronic antibody-mediated rejection. These studies should include well-designed serial protocol biopsies with evaluation by electron microscopy, C4d staining performed on frozen sections, and assessment using sensitive DSA detection methods.

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