Role of Tissue C4d in Differentiation between Acute Rejection and HCV Recurrence after Living Donor Liver Transplantation

Shaimaa Youssef Youssef Kamel;

Abstract


Liver transplantation is a well established procedure for curative treatment of various liver diseases. Hepatitis C is the most common indication for liver transplantation. Recurrence of HCV is universal leading to graft failure in up to 40% of all patients.
Inspite of continuously improving immunosuppressive therapy, acute graft rejection is still a complication after liver transplantation.
Both acute rejection and HCV recurrence often display the same clinical picture with rising serum transaminases, elevated bilirubin level and deterioration of productive liver function in the absence of perfusion deficit.
C4d is suggested to be expressed only in rejection but not in HCV recurrence cases and would be a great asset to differentiate patients with clinically suspicious symptoms in order to validate rejection diagnosis.
The aim of this study was to assess the role of tissue C4d complement fragments in liver biopsy as a marker for differentiating between acute rejection and HCV recurrence in recipients of LDLT using IHC technique.
To fulfill such purpose, the current study was conducted on 25 patients who had underwent LDLT with clinical suspicion of either acute rejection or HCV disease recurrence. All patients were subjected to detailed history taking, clinical examination, laboratory investigations including: complete liver profile. PCR (HCV RNA quantitative), CMV PCR and Doppler ultrasonography
Histopathological evaluation of liver biopsies was done for all patients. The C4d was evaluated by immuno-histochemical staining of the formalin-fixed, paraffin-embedded tissue. Patients were re-evaluated by liver function tests and transaminases within one month of treatment to determine the response of medical treatment.
The results showed that tissue C4d staining was almost present in rejection cases only. This was statistically significant in all studied tissue compartments except hepatic vein endothelium and arterial internal elastic lining that did not reach statistical significance. Therefore C4d can be considered as a new marker to differentiate patients with rejection.
Also we found that the sensitivity and diagnostic accuracy of tissue C4d in sinusoids can be further increased by serial application of tissue C4d in both liver sinusoids and portal vein endothelium in order not to miss true case.
Furthermore, the bilirubin and alkaline phosphatase were significantly higher in rejection group than HCV recurrence group. Results of the present work showed high diagnostic performance of alkaline phosphatase, total and direct bilirubin in the diagnosis of rejection.


Other data

Title Role of Tissue C4d in Differentiation between Acute Rejection and HCV Recurrence after Living Donor Liver Transplantation
Other Titles دور سي٤دي فى التمييز بين حدوث الرفض الحاد وارتجاع فيروس سي بعد زراعة الكبد الجزئى من متبرع حى
Authors Shaimaa Youssef Youssef Kamel
Issue Date 2015

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