title: Clinical significance of C4d deposition in stable renal allografts in the early post-transplantation period.
abstract: The clinical significance of C4d positivity in patients with stable graft function is undetermined. This study evaluated the clinical outcome of protocol biopsy-proven C4d-positive renal transplants with stable graft function in the early post-transplantation period. Protocol biopsies (n = 79) were performed on stable allografts on the 14th post-transplant day, and indication biopsies (n = 74) were performed on dysfunctioning allografts within one yr after transplantation. Clinical and histological findings, graft function and graft survival rates were compared between C4d-positive and C4d-negative grafts in each group. The incidence of C4d positivity was 5.1% in protocol biopsies and 9.5% in indication biopsies. In protocol biopsies, C4d-positive allografts showed minimal tubulointerstitial inflammation, and the graft function and graft survival rate did not differ from C4d-negative allografts. All C4d-positive allografts maintained stable graft function without anti-rejection therapy, and follow-up biopsies of two patients showed no C4d deposition or evidence of rejection. On the other hand, C4d-positive allografts in indication biopsies showed severe tissue injury, and the graft survival rate was significantly lower than C4d-negative allografts. In conclusion, C4d-positive allografts with stable graft function in the early post-transplantation period take an indolent course.
authors.affiliation: Transplantation Research Center, Kangnam St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hye Eun
authors.initials: HE
authors.lastname: Yoon
authors.forename: Su Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Eun-Jee
authors.initials: EJ
authors.lastname: Oh
authors.forename: Sun Cheol
authors.initials: SC
authors.lastname: Park
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: In Sung
authors.initials: IS
authors.lastname: Moon
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D015935:Complement C4b / Q000276:immunology / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000378:metabolism*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007668:Kidney / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D015935:Complement C4b