Biopsy Interpretation of the Liver (Biopsy Interpretation Series) by Torbenson Michael

Author:Torbenson, Michael
Language: eng
Format: epub
ISBN: 9781451182576
Publisher: LWW
Published: 2014-08-08T04:00:00+00:00

Immunostain Findings

Staining for C4d is used in making the diagnosis of antibody-mediated rejection. Many questions remain on the best staining methods (immunohistochemistry vs. immunofluorescence), the best antibody, and the best staining protocol. Immunofluorescence currently appears to be more sensitive.30 Positive C4d controls should also be performed and can include known cases of antibody-mediated rejection in other organs.

C4d staining in isolation is difficult to interpret. However, C4d staining can help confirm a diagnosis of antibody-mediated rejection in the setting of donor-specific antibodies, clinical graft dysfunction that is unexplained by other processes, and a biopsy that shows active injury compatible with antibody-mediated rejection—in particular, a pattern that resembles biliary obstruction. C4d staining can be seen in the portal veins, in the sinusoids, and in combined patterns. As a general rule of thumb, immunostaining tends to be stronger in the portal veins and capillaries/stroma of the portal tracts than in the sinusoids (Fig. 14.9). In turn, the sinusoidal staining tends to be stronger than that of the central veins. Which pattern is more sensitive or specific remains unclear, but in general, a diffuse pattern (defined by more than 50% of portal tracts, for example) is more useful for confirming a diagnosis of antibody-mediated rejection.25 However, to illustrate that this area of pathology is still incompletely defined, one recent study reported that C4d sinusoidal staining on frozen section is the most reliable method for C4d detection.30

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