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Updated: Jul 5, 2026
Small Bowel Transplantation In Mice
Published on: August 20, 2007
Evaluation of c4d deposition and circulating antibody in small bowel transplantation
N Patey-Mariaud de Serre1, D Canioni, F Lacaille
1Necker Enfants Malades-Pathology, Tumorothèque, Paris, France. natacha.patey-mariaud@nck.aphp.fr
Insights
Defining antibody-mediated rejection (AMR) in small bowel transplantation (SBTx) is challenging. Vascular lesions, not C4d deposition or donor-specific antibodies (DSA), appear to be a key indicator of acute rejection (AR) and poor outcomes in pediatric SBTx.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Pediatric surgery
Background:
- Consensus criteria for antibody-mediated rejection (AMR) exist for kidney and heart transplants, involving histology, donor-specific antibodies (DSA), and C4d deposition.
- Such criteria are not established for small bowel transplantation (SBTx), hindering accurate diagnosis and management of AMR in these patients.
Purpose of the Study:
- To investigate the utility of established AMR criteria (histology, DSA, C4d) in pediatric small bowel transplantation (SBTx).
- To identify reliable markers for acute rejection (AR) and predict outcomes in SBTx recipients.
Main Methods:
- Retrospective analysis of 91 biopsies from 12 pediatric SBTx recipients (including retransplantation and combined liver-SBTx).
- Evaluation of histological changes, vascular lesions, C4d deposition, and circulating donor-specific antibodies (DSA) in sera.
- Standardized grading scheme for acute rejection (AR) and assessment of clinical outcomes.
Main Results:
- C4d deposition was observed in 37% of biopsies and 50% with severe vascular lesions, but showed no clinical relevance to SBTx outcome.
- Donor-specific antibodies (DSA) were not detected in any patient sera.
- Severe vascular lesions were consistently associated with acute rejection (AR) and poor graft outcomes, with high mortality or graft loss for grades 2-3 AR within three months.
Conclusions:
- C4d deposition and DSA are not reliable indicators of AMR in pediatric SBTx.
- Grading of vascular lesions is a crucial marker for identifying acute rejection (AR) potentially resistant to standard treatment, guiding consideration for alternative therapies in SBTx.
Abstract:
Antibody-mediated rejection (AMR) consensus criteria are defined in kidney and heart transplantation by histological changes, circulating donor-specific antibody (DSA), and C4d deposition in affected tissue. AMR consensus criteria are not yet identified in small bowel transplantation (SBTx). We investigated those three criteria in 12 children undergoing SBTx, including one retransplantation and four combined liver-SBTx (SBTx), with a follow-up of 12 days to 2 years. All biopsies (91) were evaluated with a standardized grading scheme for acute rejection (AR), vascular lesions and C4d expression. Sera were obtained at day 0 and during the follow-up. C4d was expressed in 37% of biopsies with or without AR, but in 50% of biopsies with severe vascular lesions. In addition, vascular lesions were always associated with AR and a poor outcome. All children with AR (grade 2 or 3) observed before the third month died or lost the graft. DSA were never found in any studied sera. We found no evidence that C4d deposition was of any clinical relevance to the outcome of SBTx. However, the grading of vascular lesions may constitute a useful marker to identify AR that is potentially resistant to standard treatment, and for which an alternative therapy should be considered.
