Complement C4d in graft capillaries -- the missing link in the recognition of humoral alloreactivity.

摘要: Staining of C4d in graft capillaries has emerged as a useful method to detect antibody-mediated rejections situ. Demonstration capillary provided substantial clinical results and allows several conclusions: Antidonor antibodies (preformed or produced de novo) activate complement directly the graft. Capillary is present about 30% biopsies with acute chronic separates humoral component from 'pure' cell-mediated rejections. Recognition alloreactivity important, since effective treatment now available. Since can appear disappear at any time post transplantation, every transplant biopsy should be tested. incorporated 'Banff classification'. The incidence C4d-positive cases will probably decline because 'routine' application potent immunosuppressants, including mycophenolate mofetil, that inhibit antibody production. Presensitization, however, remain potential threat allografts.