C4d deposition without rejection correlates with reduced early scarring in ABO-incompatible renal allografts.
C4d deposition in peritubular capillaries is a specific marker for the presence of antidonor antibodies in renal transplant recipients and is usually associated with antibody-mediated rejection (AMR) in conventional allografts. In ABO-incompatible grafts, however, peritubular capillary C4d is often present on protocol biopsies lacking histologic features of AMR; the significance of C4d in this setting remains unclear. For addressing this, data from 33 patients who received ABO-incompatible renal allografts (after desensitization) were retrospectively reviewed. Protocol biopsies were performed at 1 and/or 3 and 6 mo after transplantation in each recipient and at 12 mo in 28 recipients. Twenty-one patients (group A) had strong, diffuse peritubular capillary C4d staining without histologic evidence of AMR or cellular rejection on their initial protocol biopsies. The remaining 12 patients (group B) had negative or weak, focal peritubular capillary C4d staining. Three grafts (two in group B) were lost but not as a result of AMR. Excluding these three patients, serum creatinine levels were similar in the two groups at 6 and 12 mo after transplantation and at last follow-up; however, recipients in group A developed significantly fewer overall chronic changes, as scored by the sum of Banff chronic indices, than group B during the first year after transplantation. These results suggest that diffuse peritubular capillary C4d deposition without rejection is associated with a lower risk for scarring in ABO-incompatible renal allografts; the generalizability of these results to conventional allografts remains unknown.
Haas
Mark
M
Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Pathology 712, Baltimore, MD 21287, USA. mhaas@jhmi.edu
Segev
Dorry L
DL
Racusen
Lorraine C
LC
Bagnasco
Serena M
SM
Locke
Jayme E
JE
Warren
Daniel S
DS
Simpkins
Christopher E
CE
Lepley
Diane
D
King
Karen E
KE
Kraus
Edward S
ES
Montgomery
Robert A
RA
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology*; D002921:Cicatrix / Q000517:prevention & control*; D015935:Complement C4b / Q000378:metabolism*; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism*; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
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