PubMed · 5053745
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D R Musher, G G Hunder, F C McDuffie. 1972. Pleural fluid complement.. https://doi.org/10.7326/0003-4819-77-3-482_3
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Long-term graft survival is mainly influenced by early graft rejection and posttransplant graft function. The ability of both complement-dependent cytotoxicity cross-match (CDC) and flow cytometry cross-match (FCXM) to predict acute rejection episodes has been evaluated by cross-matching 40 patients who received cadaveric kidney transplants, before (current serum) and after transplantation (on days 1, 7, 14, 21, 28, 60, and 90). Of the 40 patients, all of whom had a negative CDC before transplant, seven patients had a positive FCXM before transplant: five of them (5/7=71.4%) experienced severe rejection within 2 months after transplantation. In patients with a negative FCXM before transplant, the incidence of acute rejection was lower (25.8%). Pre-transplant FCXM recipients who had a positive FCXM after transplant, experienced more frequent rejection (38.5%) than those pre-transplant FCXM recipients who never had a positive FCXM (15.8%). With respect to the incidence of acute graft rejection, no difference was found between patients who had a positive CDC after transplant and those who had a negative CDC after transplant. Patients who had a positive FCXM before transplant had significantly higher creatinine levels within the first month after transplant. Immediate onset of function and accelerated lowering of the creatinine level were found to be more frequent in patients who had a negative FCXM before transplant. As early graft rejection is the largest contributing factor for the development of chronic rejection and, therefore, of graft loss, we regard FCXM as a sensitive method for predicting long-term prognosis and graft survival, due to its competence in predicting both restricted graft function and early acute rejection, in particular.
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The complement system has been shown to play a pathogenic role in only a small number of muscle diseases. A complement-induced microangiopathy is important in dermatomyositis and in the rare disorder, necrotizing myopathy with pipestem capillaries. Recent studies demonstrate the reversibility of microvascular damage in dermatomyositis by intravenous immune globulin which appears to intercept the assembly and deposition of membrane attach complex. In myasthenia gravis, complement-mediated lysis directed at the acetylcholine receptor leads to a cascade of events reducing the number of receptors, simplifying the complex architecture of the junctional folds and decreasing the available surface for the insertion of new receptors. The newest condition in which a role for complement has been demonstrated is X-linked vacuolated myopathy. The condition is of interest because membrane attack complex deposits result in shedding of complement-laden membrane fragments in contrast to a cytolytic process as the consequence of assembly of the terminal complement components.