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Title

Antibody-mediated rejection in pediatric small bowel transplantation: Capillaritis is a major determinant of C4d positivity in intestinal transplant biopsies

Authors
Rabant, Marion
Racapé, Maud
Taupin, Jean Luc
Aubert, Olivier
Bruneau, Julie
Barbet, Patrick
Goulet, Olivier
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Published in American Journal of Transplantation. 2018, vol. 18, no. 9, p. 2250-2260
Abstract The diagnostic criteria for antibody-mediated rejection (ABMR) after small bowel transplantation (SBT) are not clearly defined, although the presence of donor-specific antibodies (DSAs) has been reported to be deleterious for graft survival. We aimed to determine the incidence and prognostic value of DSAs and C4d in pediatric SBT and to identify the histopathologic features associated with C4d positivity. We studied all intestinal biopsies (IBx) obtained in the first year posttransplantation (N = 345) in a prospective cohort of 23 children. DSAs and their capacity to fix C1q were identified by using Luminex technology. Eighteen patients (78%) had DSAs, and 9 had the capacity to fix C1q. Seventy-eight IBx (22.6%) were C4d positive. The independent determinants of C4d positivity were capillaritis grades 2 and 3 (odds ratio [OR] 4.02, P = .047 and OR 5.17, P = .003, respectively), mucosal erosion/ulceration (OR 2.8, P = .019), lamina propria inflammation grades 1 and 2/3 (OR 1.95, P = .043 and OR 3.1, P = .016, respectively), and chorion edema (OR 2.16, P = .028). Complement-fixing DSAs and repeated C4d-positive IBx were associated with poor outcome (P = .021 and P = .001, respectively). Our results support that capillaritis should be considered as a feature of ABMR in SBT and identify C1q-fixing DSAs and repeated C4d positivity as potential markers of poor outcome.
Keywords BiopsyClassification systemsClinical research/practiceIntestinal (allograft) function/dysfunctionIntestine/multivisceral transplantationPathology/histopathologyRejection: antibody-mediated (ABMR)BiopsyClassification systemsClinical research/practiceIntestinal (allograft) function/dysfunctionIntestine/multivisceral transplantationPathology/histopathologyRejection: antibody-mediated (ABMR)
Identifiers
PMID: 29397036
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Research group Développement du tube digestif chez les vertébrés (900)
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RABANT, Marion et al. Antibody-mediated rejection in pediatric small bowel transplantation: Capillaritis is a major determinant of C4d positivity in intestinal transplant biopsies. In: American Journal of Transplantation, 2018, vol. 18, n° 9, p. 2250-2260. doi: 10.1111/ajt.14685 https://archive-ouverte.unige.ch/unige:128293

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Deposited on : 2020-01-06

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