Abstract
Background. Previous data showed that the predominance of intraglomerular T-bet or GATA3 is correlated with different mechanisms of rejection, suggesting that the ratio of T-bet/GATA3 might be used to distinguish antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR). Methods. We compared the intraglomerular T-bet/GATA3 ratio in ABMR and TCMR. The intragraft expression of T-bet and GATA3 was studied via immunohistochemistry. The correlation of the diagnosis of AMR with the ratio of T-bet/GATA3 was examined. Results. Both intraglomerular T-bet- and GATA3-expressing cells were increased during acute rejection. T-bet/GATA3>1 was strongly correlated with ABMR (93.3% versus 18.2%). The incidence of positive HLA-I/II antibodies and glomerulitis is significantly higher in T-bet/GATA3>1 group (P < 0.001, 0.013, resp.). The scores of peritubular capillary inflammation and glomerulitis were also higher in T-bet/GATA3>1 group (P = 0.052, P < 0.001, resp.). Nevertheless, T-bet/GATA3>1 is also correlated with C4d-negative ABMR and resistance to steroid treatment. Compared with C4d deposition, T-bet/GATA3>1 had a slight lower (90% versus 100%) specificity but a much higher (87.5% versus 68.8%) sensitivity. Conclusion. Our data suggested that intraglomerular predominance of T-bet over GATA3 might be used as diagnosis maker of ABMR in addition to C4d, especially in C4d-negative cases.
Highlights
With the introduction of new strong immunosuppressants, the incidence of early acute rejection is decreasing; antibody-mediated rejection (ABMR) remains an important barrier to successful renal transplantation [1,2,3,4,5]
Twenty-six renal allograft recipients who developed acute rejection were included in this study, including 11 cases of C4d-positive ABMR, 10 cases of T-cell-mediated acute rejection (TCMR), and 5 cases of C4d-negative ABMR
In our previous observation [15], we found that predominance of intraglomerular T-bet or GATA3 is correlated with different mechanisms of acute renal allograft rejection, suggesting that ratio of T-bet/GATA3 might be useful to distinguish ABMR from T-cell-mediated rejection (TCMR)
Summary
With the introduction of new strong immunosuppressants, the incidence of early acute rejection is decreasing; antibody-mediated rejection (ABMR) remains an important barrier to successful renal transplantation [1,2,3,4,5]. The predominance of intraglomerular T-bet expression relative to GATA3 expression was associated with poor response to bolus steroid treatment. These data suggest that the ratio of Tbet/GATA3 might be used to distinguish between ABMR and TCMR. This study was performed to evaluate the significance of intraglomerular T-bet/GATA3>1 as marker of ABMR, especially in the diagnosis of C4d-negative ABMR. Previous data showed that the predominance of intraglomerular T-bet or GATA3 is correlated with different mechanisms of rejection, suggesting that the ratio of T-bet/GATA3 might be used to distinguish antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR). Our data suggested that intraglomerular predominance of T-bet over GATA3 might be used as diagnosis maker of ABMR in addition to C4d, especially in C4d-negative cases
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