PMID- 15268735
OWN - NLM
STAT- MEDLINE
DCOM- 20050214
LR  - 20230124
IS  - 1600-6135 (Print)
IS  - 1600-6135 (Linking)
VI  - 4
IP  - 8
DP  - 2004 Aug
TI  - Acute humoral rejection of human lung allografts and elevation of C4d in 
      bronchoalveolar lavage fluid.
PG  - 1323-30
AB  - Antibody-mediated rejection is well established for renal allografts but remains 
      controversial for lung allografts. Cardinal features of antibody-mediated 
      rejection in renal allografts include antibodies to donor human leukocyte antigen 
      (HLA) and evidence for antibody action, such as complement activation 
      demonstrated by C4d deposition. We report a lung allograft recipient with 
      circulating antibodies to donor HLA who failed treatment for acute cellular 
      rejection but responded to therapy for humoral rejection. To address the second 
      criteria for antibody-mediated rejection, we determined whether complement 
      activation could be detected by measuring C4d in bronchoalveolar lavage fluid 
      (BALF) by ELISA. Airway allergen challenge of asthmatics activates the complement 
      pathway; therefore, we used BALF from asthmatics pre- and post-allergen challenge 
      to measure C4d. These controls demonstrated that ELISA could detect increases in 
      C4d after allergen challenge. BALF from the index patient had elevated C4d 
      concomitant with graft dysfunction and anti-donor HLA in the absence of 
      infection. Analysis of BALF from 25 additional lung allograft recipients showed 
      that C4d concentrations >100 ng/mL were correlated with anti-HLA antibodies (p = 
      0.006), but were also observed with infection and in asyptomatic patients. The 
      findings support the occurrence of anti-HLA-mediated lung allograft rejection and 
      suggest that C4d measurement in BALF may be useful in diagnosis.
FAU - Miller, Geraldine G
AU  - Miller GG
AD  - Division of Infectious Diseases, Department of Medicine, Vanderbilt University 
      School of Medicine, Nashville, TN, USA. geraldine.miller@vanderbilt.edu
FAU - Destarac, Luis
AU  - Destarac L
FAU - Zeevi, Adriana
AU  - Zeevi A
FAU - Girnita, Alin
AU  - Girnita A
FAU - McCurry, Kenneth
AU  - McCurry K
FAU - Iacono, Aldo
AU  - Iacono A
FAU - Murray, John J
AU  - Murray JJ
FAU - Crowe, Deborah
AU  - Crowe D
FAU - Johnson, Joyce E
AU  - Johnson JE
FAU - Ninan, Mathew
AU  - Ninan M
FAU - Milstone, Aaron P
AU  - Milstone AP
LA  - eng
GR  - GM15431/GM/NIGMS NIH HHS/United States
GR  - HL53771/HL/NHLBI NIH HHS/United States
GR  - HL65189/HL/NHLBI NIH HHS/United States
GR  - M01 RR00095/RR/NCRR NIH HHS/United States
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Am J Transplant
JT  - American journal of transplantation : official journal of the American Society of 
      Transplantation and the American Society of Transplant Surgeons
JID - 100968638
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Isoantibodies)
RN  - 0 (Peptide Fragments)
RN  - 80295-50-7 (Complement C4b)
RN  - 80295-52-9 (complement C4d)
SB  - IM
MH  - Antibodies
MH  - Asthma/*metabolism/pathology
MH  - Biopsy
MH  - Bronchoalveolar Lavage Fluid/*immunology
MH  - Complement Activation
MH  - Complement C4b/*biosynthesis
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Flow Cytometry
MH  - Graft Rejection
MH  - Graft Survival
MH  - HLA Antigens/chemistry
MH  - Humans
MH  - Hypoxia
MH  - Immunoglobulins, Intravenous/chemistry
MH  - Isoantibodies
MH  - Lung/pathology
MH  - Lung Transplantation/immunology/*methods
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*biosynthesis
MH  - Plasma/metabolism
MH  - Thorax/pathology
MH  - Time Factors
MH  - Tissue Donors
MH  - Tomography, X-Ray Computed
MH  - Transplantation, Homologous
EDAT- 2004/07/23 05:00
MHDA- 2005/02/16 09:00
CRDT- 2004/07/23 05:00
PHST- 2004/07/23 05:00 [pubmed]
PHST- 2005/02/16 09:00 [medline]
PHST- 2004/07/23 05:00 [entrez]
AID - S1600-6135(22)07914-X [pii]
AID - 10.1111/j.1600-6143.2004.00508.x [doi]
PST - ppublish
SO  - Am J Transplant. 2004 Aug;4(8):1323-30. doi: 10.1111/j.1600-6143.2004.00508.x.