학술논문
Free Airway C4d after Lung Transplantation - A Quantitative Analysis of Bronchoalveolar Lavage Fluid.
Document Type
Article
Author
Heigl, Tobias; Saez-Gimenez, Berta; Van Herck, Anke; Kaes, Janne; Sacreas, Annelore; Beeckmans, Hanne; Ambrocio, Gene P.L.; Kwakkel-Van Erp, Hanneke; Ordies, Sofie; Vanstapel, Arno; Verleden, Stijn E.; Neyrinck, Arne P.; Ceulemans, Laurens J.; Van Raemdonck, Dirk E.; Verbeken, Erik; Verleden, Geert M.; Vos, Robin; Vanaudenaerde, Bart
Source
Subject
*LUNG transplantation
*BRONCHOALVEOLAR lavage
*C-reactive protein
*QUANTITATIVE research
*RESPIRATORY infections
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Language
ISSN
0966-3274
Abstract
In recent years, the utility of vascular complement factor 4d (C4d) deposition as diagnostic tool for antibody mediated rejection (AMR) after lung transplantation, has become a controversial issue. We aimed to pinpoint the problematic nature of C4d as biomarker with a simple experiment. We quantified C4d in broncho-alveolar lavage (BAL) of lung transplant patients with diverse post-transplant complications in 3 different settings of clinically clear cases of: 1/ chronic lung allograft dysfunction (CLAD); 2/ acute complications acute rejection (AR), lymphocytic bronchiolitis (LB), antibody-mediated rejection (AMR) and respiratory infection (INF); 3/ patients with parallel C4d immunostaining and Anti-HLA. All groups were compared to BAL of stable patients. C4d was measured via standard ELISA. C4d was increased in CLAD, predominantly in RAS (p = 0.0026) but not in BOS (p = 0.89). C4d was increased in all acute events, AR (p = 0.0025), LB (p < 0.0001), AMR (p = 0.0034), infections (p < 0.0001). In patients with parallel C4d immunostaining and serum HLA antibodies, C4d was increased in C4d-/HLA- (p = 0.0011); C4d-/HLA+ (p = 0.013); HLA+/C4d + (p = 0.0081). A correlation of systemic C-reactive protein (CRP) with C4d was found in all patients (r = 0.49; p < 0.0001). We hypothesize that free C4d in BAL may only be representative of a general immune response in the transplanted lung. [ABSTRACT FROM AUTHOR]