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C4d staining and morphology in protocol biopsies

C4d staining and morphology in protocol biopsies. Michael Mengel* For the ESPRIT-Group European Study Group For Protocol Biopsies In Renal Transplantation. *Disclosure: M.M. received travel grants form Wyeth and Roche. Multicentric Study. 3 European TX-Centers Protocol- und Indication Bx

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C4d staining and morphology in protocol biopsies

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  1. C4d staining and morphology in protocol biopsies Michael Mengel* For the ESPRIT-Group European Study Group For Protocol Biopsies In Renal Transplantation *Disclosure: M.M. received travel grants form Wyeth and Roche

  2. Multicentric Study • 3 European TX-Centers • Protocol- und Indication Bx • Classification according up-dated Banff • unstained paraffin slides from all centers • C4d positive > 25% of PTC stained • 25-50% focal positive • >50% diffuse positive • C4d negative < 25% of PTC stained • correlation with morphological and clinical parameters

  3. Incidence of C4d

  4. Indication biopsies: C4d clinico-pathological correlation

  5. protocol biopsies: C4d clinico-pathological correlation

  6. 24 C4d+ protocol Bx matched with 72 C4d- protocol Bx for: Age, Sex, time point of Bx, Banff grade

  7. F.R., male, born 1944Renal-Transplantation 31.08.01 Analgesic nephropathy, stone kidneys Hemodialysis 11/1988 1. Transplantation 5/1990 Transplant failure 1/1999 with CAN 2. Transplantation 8/2001 Relapsing peptic ulcers (bleeding), Hypertension (4 antihypertensive drugs), Hyperlipoproteinemia, Coronary heart disease

  8. K 1

  9. K 1-C4d+

  10. K 2

  11. K 2-C4d+

  12. Indication

  13. K 3

  14. F.R., male, born 1944Renal-Transplantation 31.08.01 S-Creatinine (µmol/L) Predni CSA MMF RR Med (4) Pravastatin ASS Biopsies 1,3 0,9 0,5 U- Protein (g/L) 0,4 0,3 0,2 0,08

  15. Summary • Incidence for C4d in protocol bx significantly lower • Incidencevaries between centers • Incidence is higher with presensitized patients • focal C4d stain correlates with AHR morphology • C4d in protocol bx less often with cellular rejection • cases of “subclinical” humoral rejection • prognostic relevance: • No acute graft losses • Harbinger of chronic humoral rejection??

  16. ESPRIT-Group European Study Group For Protocol Biopsies In Renal Transplantation • Hannover-Germany • Hermann Haller • Anke Schwarz • Wilfried Gwinner • Michael Mengel Barcelona-Spain Daniel Seron Francesco Moreso Marta Carrera Antwerp-Belgium Marc De Broe Jean-Louis Bosmans Johannes Bogers

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