The Diagnostic Value of Transcription Factors T-betGATA3 Ratio in Predicting Antibody-Mediated Rejection

Abstract EN

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.