title: Peritubular capillary C4d staining in late acute renal allograft rejection--is it relevant?
abstract: BACKGROUND
  In the early post-transplant period, renal allograft rejection with diffuse peritubular capillary (PTC) C4d deposition predicts poor graft survival. In the late post-transplant setting, that is, one or more yr after transplantation, the implication of diffuse PTC C4d deposition is still a topic of debate. The purpose of our study was to see if diffuse PTC C4d deposition, in late acute rejection (LAR), occurring more than one yr post-transplant, has any impact on graft survival and function.
  
  
  METHODS
  We selected cases, both cadaveric as well as living donor renal transplant recipients, in whom acute rejection with PTC C4d deposition was first detected after the first year post-transplant. Recipients with multiple acute rejection episodes during the first year post-transplant were excluded from the study. The first biopsy diagnosed with LAR was considered the index biopsy (n = 40). We formed two groups: group 1, C4d-positive LAR (n = 20), and group 2, C4d-negative LAR (n = 20). Groups were matched for maintenance and post-rejection immunosuppressive therapy, baseline serum creatinine levels before the time of the index biopsy, time from transplant to index biopsy, as well as chronic allograft damage index (CADI) score in the index biopsies. We compared the rate of graft loss, and the graft function of the surviving grafts at the end of the study period, as well as histologic parameters in the index biopsy specimens between the two groups. The mean follow-up period was 20 months.
  
  
  RESULTS
  No significant differences in the rate of graft loss or graft function were found between groups 1 and 2 at the end of the follow-up period. Histologically, PTC margination and transplant glomerulopathy were more common in the C4d-positive group, and this difference was statistically significant. There was no statistically significant difference in the degree of plasma cell infiltrates.
  
  
  CONCLUSIONS
  Unlike in the acute setting, the presence or absence of PTC C4d staining in renal allografts with LAR may not have a predictive value regarding graft outcome.
authors.affiliation: Department of Pathology, The Ohio State University, Columbus, OH, USA.
authors.forename: Anjali A
authors.initials: AA
authors.lastname: Satoskar
authors.forename: Amy M
authors.initials: AM
authors.lastname: Lehman
authors.forename: Gyongyi M
authors.initials: GM
authors.lastname: Nadasdy
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Sedmak
authors.forename: Todd E
authors.initials: TE
authors.lastname: Pesavento
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Henry
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Pelletier
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Ferguson
authors.forename: Tibor
authors.initials: T
authors.lastname: Nadasdy
mesh_terms: D000328:Adult; D002196:Capillaries / Q000378:metabolism*; D015935:Complement C4b / Q000378:metabolism*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000378:metabolism*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007150:Immunohistochemistry; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D007684:Kidney Tubules / Q000098:blood supply* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism*; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d