2013 - ISBTS 2013 Symposium

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Posters and Exhibition

15.12 - Assessment of post-implant immediate C4d deposits, correlation with lymphocytotoxic crossmatch and cold-ischemia time in 13 intestinal grafts

Presenter: Jorge, Calvo, , Spain
Authors: Jorge Calvo¹, Patricia LÃ³pez-GarcÃa², Carmelo Loinaz¹, Carolina Ibarrola², Carlos Jimenez¹, Francisco Colina², Alvaro GarcÃa-Sesma¹, Carlos BallestÃn², Felix Cambra¹, Enrique Moreno¹

Assessment of post-implant immediate C4d deposits, correlation with lymphocytotoxic crossmatch and cold-ischemia time in 13 intestinal grafts

Jorge Calvo¹, Patricia LÃ³pez-GarcÃa², Carmelo Loinaz¹, Carolina Ibarrola², Carlos Jimenez¹, Francisco Colina², Alvaro GarcÃa-Sesma¹, Carlos BallestÃn², Felix Cambra¹, Enrique Moreno¹

¹Surgery, University Hospital 12 de Octubre, Madrid, Spain; ²Pathology, University Hospital 12 de Octubre, Madrid, Spain

Introduction

C4d deposits are predictive of humoral rejection in kidney transplantation. It is necessary to know the usefulness of C4d deposits in interpreting biopsies taken immediately after the implantation of bowel grafts in order to evaluate the possibility of humoral rejection

Aim

To identify the C4d deposit pattern in graft mucosa immediately after implantation and to detect if would be a valuable tool to predict humoral or acute rejection

Materials and methods

Immunohistochemycal demonstration of C4d deposits in paraffin embeded mucosal biopsies of 12 grafts was performed in first post-transplant day. Diffuse intense staining of the capillar endothelium was considered positive; absent, focal or weak stain as negative. Preservation injury grade was registered in these biopsies. Donor-specific preformed serum antibodies were determined with the complement dependent citotoxicity serologic technique (crossmatch). Cold ischemia times of the grafts were registered. To assess their evolution 19 enteroscopic follow-up biopsies from day 2nd to 6th(3.6±1.1) were evaluated.

Results

Diffuse intense C4d deposits were observed in 2 grafts, focal and weak in 4 and negative in 6. Mean cold ischemia time was 327±101 min. (135-480). Two cases of positive crossmatch showed histologically moderate preservation injury. C4d deposits were positive in only one of these, with cold ischemia time of 360 min. Diffuse positive C4d deposits were observed in another case without preformed antibodies with cold ischemia of 475 min. In their follow-up biopsies nor humoral neither acute rejection were observed.

Conclusions

1.- Endothelial C4d deposits were not useful to diagnose humoral rejection. 2.- They did not predict acute rejection during the early post-transplant period. 3.- There was not correlation between positive deposits and preservation injury grade or prolonged cold ischemia time. 4.- Staining did not correlate with positive lymphocytotoxic crossmatch

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