Article Figures & Data
Figures
- Figure 1.
Light micrograph of a renal allograft biopsy with acute humoral rejection, showing accumulation of neutrophils in peritubular capillaries. Periodic acid-Schiff stain. Magnification, ×256.
- Figure 2.
Immunofluorescence micrograph of renal allograft biopsies stained for C4d (see Materials and Methods). (A) Acute humoral rejection, with diffuse bright staining for C4d in the peritubular capillaries. (B) Acute cellular rejection, which has C4d in tubular basement membranes, but no detectable deposition of C4d in peritubular capillaries. Magnification, ×200.
- Figure 3.
Double immunofluorescence stains of renal allograft biopsies with acute humoral rejection. In the same field, the green filter (A) shows C4d and the red filter (B) type IV collagen codistributed in the peritubular capillaries. The tubular basement membrane stains uniformly for type IV collagen but only focally for C4d. In another pair of fields, the red filter (C) shows C4d in the same distribution as the endothelial marker, Ulex lectin (D, green filter). Portions of vessels show C4d deposits without Ulex lectin reactivity (arrow), suggesting that the C4d remains after loss or injury of the endothelium. Magnification, ×200.
Tables
Patient Donor Source Circulating Antibodies to Donor Biopsy No.b PTC PMN PTC IgM PTC C3 PTC C4d Graft Survivalb Creatinine (mg/dl) at 1 yr T Cells B Cells aPTC, peritubular capillaries; PMN, polymorphonuclear leukocytes; ND, not determined; CD, cadaveric kidney. The number after CD indicates the number of renal allografts the patient has received. bThe number in parentheses indicates days posttransplantation. cPatient was presensitized at time of transplantation. dThis patient's original disease was hereditary nephritis. His clinical course was complicated by the presence of anti-glomerular basement membrane antibodies in the kidney. eDetermined by flow cytometry. fGraft has survived the first 6 wk. Patients 5 through 10 were treated with a rescue protocol combining tacrolimus with mycophenolate and/or plasma exchange (10). 1 CD 1:4 >1:8 1 (5) 2+ - - 2 to 3+ Failed (8) 2 CD >1:8 >1:8 1 (8) 3+ + - 4+ Survived 1.6 3 CD, 3 ND ND 2 (17) 2+ - - 1 to 2+ Failed (180) >1:8 >1:8 3 (33) 2+ - - 2+ 4c CD, 2 1:32 Negative 1 (6) 2+ - + 3+ Failed (23) 1:16 ND 2 (12) 2+ - +/- 3+ 5 Daughter 1:32 >1:8 1 (7) 2+ - - 4+ Survived 1:16 ND 2 (34) 3+ - - 4+ 1.8 6 CD >1:8 1:4 2 (26) 2+ - - 4+ Survived 1.2 7 CD 1:128 1:4 1 (14) 2+ - + 4+ Survived >1:512 1:64 2 (21) 3+ - - 4+ 1.1 8 CD, 3 Negative >1:8 1 (7) 1 to 2+ - - 4+ Survived 1.3 9d CD, 3 Positivee Positivee 1 (3) 3+ + + 4+ Failed (10) 10 Mother Negative 1:256 1 (6) 3+ + + 4+ Survivedf 1:2 1:128 2 (17) 3+ - + 3+ Weak 1:16 3 (24) 2 to 3+ - + 2 to 3+ 3.1 Diagnosis Biopsies Examined No. with Antibodies No. with PTC No. with PTC C4d Retrospective testing of this patient's serum revealed circulating anti-class I antibodies. aCsA, cyclosporin A; NDAR, no diagnostic abnormality recognized. Other abbreviations as in Table 1. bIn one of the six cases with morphologic features of CsA toxicity and without ptc pmn, the ptc stained positively for C4d. Acute cellular rejection 14 0 of 8 4 of 14 0 of 14 CsA toxicity 6 1 of 6 3 of 6 1 of 6b NDAR/donor biopsy 4 0 of 4 0 of 4
Complement Activation in Acute Humoral Renal Allograft Rejection
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