Original Clinical SciencePathologic classification of antibody-mediated rejection correlates with donor-specific antibodies and endothelial cell activation
Section snippets
EMB and patients
A total of 293 protocol EMBs were performed in 113 patients in our institution between October 1, 2009, and September 30, 2010. Two patients were excluded because of inadequate EMB specimens. Patient characteristics of the 111 recipients included in the study are given in Table 1. All recipients in our center undergo a routine protocol EMB according to a pre-determined tapering schedule with early and late assessments of graft histology. In our practice, a protocol EMB is performed in a
Histopathologic characteristics and pAMR classification
Histopathology results are summarized in Table 2 and illustrated in Figure 2. MI (Figure 2A), defined by the presence of mononuclear cells within capillaries, was present in 12.9% of the EMB specimens and observed in early and late (> 2 years) EMB specimens. C4d (Figure 2B) and CD68 (Figure 2C) were positive in 0.7% and 3.6% of the samples, respectively. According to the pAMR classification, pAMR0, pAMR1(I+), pAMR1(H+), and pAMR2 were diagnosed in 86.8%, 0.4%, 9.6%, and 3.2% of the EMB samples,
Discussion
The present study evaluates the pathologic classification of AMR in heart transplantation in a prospective, non-selected series of protocol EMB specimens with concomitant DSA testing. Our main result is that the pAMR classification correlates with DSA and with in situ markers of endothelial cell activation through the mTOR pathway.
Our study gives insight into the incidence of AMR in a non-selected series of heart recipients. Herein, pAMR1 and pAMR2 specimens represented 9.3% and 3.6% of the
Disclosure statement
The authors thank the staff from Hôpital Européen Georges-Pompidou, Chantal Mandet, Nicole Pfister, and Sophie Maillard, for technical assistance.
This work was supported by the Agence de la Biomédecine grant 2012 to P.B. A.L. and J.P. D.V.H. are members of the Centaure group.
Part of this study was presented as an oral communication at the Thirty-first Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation, San Diego, California, April 13–16, 2011,
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