The importance of C4d in biopsies of kidney transplant recipients.
Antibody-mediated rejection (AMR) is highly detrimental to the prolonged survival of transplanted kidneys. C4d has been regarded as a footprint of AMR tissue damage, and the introduction of C4d staining in daily clinical practice aroused an ever-increasing interest in the role of antibody-mediated mechanisms in allograft rejection. Despite the general acceptance of the usefulness of C4d in the identification of acute AMR, the data for C4d staining in chronic AMR is variable. The presence of C4d in the majority of the biopsies with features of chronic antibody-mediated rejection is reported, but this rejection without C4d staining is observed as well, suggesting that C4d is specific but not sensitive. Further studies on AMR with positive C4d staining in biopsy specimens are really important, as well as the study of novel routine markers that may participate in the pathogenesis of this process.
Discipline of General Pathology, Nephropathology Service, Federal University of Triângulo Mineiro, Frei Paulino, 30, 38025-180 Uberaba, Brazil. rosana@patge.uftm.edu.br
Rosana Rosa Miranda
RR
Corrêa
Juliana Reis
JR
Machado
Marcos Vinícius
MV
da Silva
Fernanda Rodrigues
FR
Helmo
Camila Souza Oliveira
CS
Guimarães
Laura Penna
LP
Rocha
Ana Carolina Guimarães
AC
Faleiros
Marlene Antônia
MA
dos Reis
D000920:Antibody-Dependent Cell Cytotoxicity; D001706:Biopsy; D015935:Complement C4b / Q000276:immunology*; D003165:Complement System Proteins / Q000276:immunology; D005921:Glomerulonephritis / Q000209:etiology; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000276:immunology* / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D010446:Peptide Fragments / Q000276:immunology*
D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d; D003165:Complement System Proteins