title: C4d deposition without rejection correlates with reduced early scarring in ABO-incompatible renal allografts.
abstract: 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.
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Pathology 712, Baltimore, MD 21287, USA. mhaas@jhmi.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Haas
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Racusen
authors.forename: Serena M
authors.initials: SM
authors.lastname: Bagnasco
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Warren
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Diane
authors.initials: D
authors.lastname: Lepley
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kraus
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
mesh_terms: 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
chemical_list: D000017:ABO Blood-Group System; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
references.citation: Am J Transplant. 2006 Aug;6(8):1829-40
references.pmid: 16889542
references.citation: Transplantation. 2003 Feb 15;75(3):258-62
references.pmid: 12589143
references.citation: Am J Transplant. 2008 Jan;8(1):32-40
references.pmid: 17973967
references.citation: Am J Transplant. 2005 May;5(5):1130-6
references.pmid: 15816896
references.citation: Am J Transplant. 2006 Aug;6(8):1841-7
references.pmid: 16780546
references.citation: J Am Soc Nephrol. 1999 Oct;10(10):2208-14
references.pmid: 10505698
references.citation: Transplantation. 2004 Nov 27;78(10):1471-8
references.pmid: 15599311
references.citation: Transplantation. 2003 Apr 15;75(7):971-7
references.pmid: 12698082
references.citation: J Am Soc Nephrol. 2002 Sep;13(9):2371-80
references.pmid: 12191982
references.citation: Am J Transplant. 2007 Dec;7(12):2712-22
references.pmid: 17941957
references.citation: Transplantation. 1993 Aug;56(2):335-7
references.pmid: 8356587
references.citation: Transplantation. 2003 Aug 27;76(4):730-1
references.pmid: 12973118
references.citation: Am J Transplant. 2004 Jan;4(1):101-7
references.pmid: 14678040
references.citation: Transplantation. 2000 Sep 27;70(6):887-95
references.pmid: 11014642
references.citation: Arch Pathol Lab Med. 2008 Jan;132(1):37-42
references.pmid: 18181671
references.citation: Clin Nephrol. 2006 Mar;65(3):173-9
references.pmid: 16550748
references.citation: Am J Transplant. 2007 Dec;7(12):2757-68
references.pmid: 17924997
references.citation: Am J Transplant. 2007 Mar;7(3):576-85
references.pmid: 17229067
references.citation: Am J Transplant. 2005 May;5(5):1050-6
references.pmid: 15816885
references.citation: J Am Soc Nephrol. 2002 Mar;13(3):779-787
references.pmid: 11856785
references.citation: J Am Soc Nephrol. 2001 Mar;12(3):574-582
references.pmid: 11181806
references.citation: Am J Transplant. 2008 Jan;8(1):86-94
references.pmid: 18021283
references.citation: Kidney Int. 1997 Jan;51(1):310-6
references.pmid: 8995748
references.citation: Transplantation. 1993 Apr;55(4):785-9
references.pmid: 8475552
references.citation: Transplantation. 2003 Mar 15;75(5):663-5
references.pmid: 12640306
references.citation: J Am Soc Nephrol. 2002 Apr;13(4):1091-1099
references.pmid: 11912271
references.citation: Am J Transplant. 2008 Apr;8(4):753-60
references.pmid: 18294345
references.citation: Kidney Int. 1999 Feb;55(2):713-23
references.pmid: 9987096
references.citation: N Engl J Med. 2003 Dec 11;349(24):2326-33
references.pmid: 14668458
references.citation: Am J Transplant. 2003 Aug;3(8):952-60
references.pmid: 12859529
references.citation: Clin Transplant. 1999;13 Suppl 1:33-7
references.pmid: 10751054
references.citation: J Am Soc Nephrol. 2002 Jan;13(1):234-241
references.pmid: 11752043
references.citation: Transplantation. 1999 May 27;67(10):1319-24
references.pmid: 10360584
references.citation: Transplantation. 1998 Jan 27;65(2):224-8
references.pmid: 9458019
references.citation: Am J Transplant. 2007 Sep;7(9):2124-32
references.pmid: 17608832
references.citation: Transplantation. 2001 Feb 27;71(4):515-23
references.pmid: 11258430
references.citation: Transplantation. 2004 Oct 27;78(8):1093-8
references.pmid: 15502700