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CD68/CD31 immunohistochemistry double stain demonstrates increased accuracy in diagnosing pathologic antibody-mediated rejection in cardiac transplant patients.

Publication ,  Journal Article
Glass, C; Butt, YM; Gokaslan, ST; Torrealba, JR
Published in: Am J Transplant
November 2019

Pathologic antibody-mediated rejection (pAMR) occurs in 10% of cardiac transplant patients and is associated with increased mortality. The endomyocardial biopsy remains the primary diagnostic tool to detect and define pAMR. However, certain challenges arise for the pathologist. Accurate identification of >10% of intravascular macrophages along with endothelial swelling, which remains a critical component of diagnosing pAMR, is one such challenge. We used double labeling with an endothelial and histiocytic marker to improve diagnostic accuracy. Twenty-two cardiac transplant endomyocardial biopsies were screened using a CD68/CD31 immunohistochemical (IHC) double stain. To determine whether pAMR diagnosis would change using the double stain, intravascular macrophage staining was compared to using CD68 alone. Twenty-two cardiac pAMR cases from patients were included. Fifty-nine percent of cases previously called >10% intravascular macrophage positive by CD68 alone were called <10% positive using the CD68/CD31 double stain. Not using the double stain was associated with a significant overcall. In C4d-negative cases, using the CD68/CD31 double stain downgraded the diagnosis of pAMR2 to pAMR1 in 32% of cases. It was concluded that more than one third of patients were overdiagnosed with pAMR using CD68 by IHC alone. We demonstrate the value of using a CD68/CD31 double stain to increase accuracy.

Duke Scholars

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

November 2019

Volume

19

Issue

11

Start / End Page

3149 / 3154

Location

United States

Related Subject Headings

  • Tissue Donors
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Platelet Endothelial Cell Adhesion Molecule-1
  • Middle Aged
  • Male
  • Macrophages
  • Lectins, C-Type
 

Citation

APA
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ICMJE
MLA
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Glass, C., Butt, Y. M., Gokaslan, S. T., & Torrealba, J. R. (2019). CD68/CD31 immunohistochemistry double stain demonstrates increased accuracy in diagnosing pathologic antibody-mediated rejection in cardiac transplant patients. Am J Transplant, 19(11), 3149–3154. https://doi.org/10.1111/ajt.15540
Glass, Carolyn, Yasmeen M. Butt, Sefik Tunc Gokaslan, and Jose R. Torrealba. “CD68/CD31 immunohistochemistry double stain demonstrates increased accuracy in diagnosing pathologic antibody-mediated rejection in cardiac transplant patients.Am J Transplant 19, no. 11 (November 2019): 3149–54. https://doi.org/10.1111/ajt.15540.
Glass, Carolyn, et al. “CD68/CD31 immunohistochemistry double stain demonstrates increased accuracy in diagnosing pathologic antibody-mediated rejection in cardiac transplant patients.Am J Transplant, vol. 19, no. 11, Nov. 2019, pp. 3149–54. Pubmed, doi:10.1111/ajt.15540.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

November 2019

Volume

19

Issue

11

Start / End Page

3149 / 3154

Location

United States

Related Subject Headings

  • Tissue Donors
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Platelet Endothelial Cell Adhesion Molecule-1
  • Middle Aged
  • Male
  • Macrophages
  • Lectins, C-Type