Immunohistochemistry Staining of C4d to Diagnose Antibody-mediated Rejection in Cardiac Transplantation

Deposition of C4d and C3d in cardiac transplants: A factor in the development of coronary artery vasculopathy

“…23,24 The cardiac transplantation study by Poelzl et al 18 further supports the contention that C4d deposition and AMR is involved in the development of CAV. However, given our findings and the results of others 18,21 there appears to be a state of consistent complement activation and deposition in the graft. This makes interpretation of biopsies with complement deposition problematic in terms of diagnosing AMR.…”

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

“…[23][24][25] Currently, C4d is used frequently to diagnose AMR, and some authors suggest that C4d can be used as an immunopathologic surrogate for AMR. [25][26][27][28][29][30][31][32] C4d positivity is also used in combination with histological features-with circulating DSA, or clinical graft dysfunction. 23,[33][34][35][36] Depending on how restrictive the pathological definition of AMR is (ie, number of criteria required), the reported incidence varies, with lower reported incidence with more criteria required.…”

“…In this study, the diagnosis of AMR was based on demonstration of capillary endothelial cell swelling, interstitial hemorrhage, interstitial edema and neutrophil infiltration, the presence of CD68 + macrophages within capillary cells, and Immunopathology was conducted only on cases with suspicious histopathology or on clinical request. The following sets in parentheses represent multiple manuscripts from the same institutional transplantation program: (1, 2, 5, 18, 22); (10,11,24,29); (28,33,34); (7,15,23); (3,26); (12,13); (14,20).…”

The ISHLT working formulation for pathologic diagnosis of antibody-mediated rejection in heart transplantation: Evolution and current status (2005–2011)

“…There is little published evidence on correlation of paraffin section IC with frozen section IF using the latter as the gold standard (Table 3). 25,35,42,45 The literature is also limited on the role of C3d in addition to C4d in evolution of cardiac AMR (Table 4). 15,26,27,40 Despite different approaches, centers using paraffin IC arrive at similar C4d staining conclusions.…”