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Clinical and pathological correlations of C4d immunostaining and its infl uence on the outcome of kidney transplant recipients

By Virna Nowotny Carpio, Carolina Rech, Evlyn Isabel Eickhoff, Karla Laís Pegas, Maria Isabel Albano Edelweiss, Luiz Felipe Santos Gonçalves, Roberto Ceratti Manfro and Francisco Veríssimo Veronese


INTRODUCTION: C4d is a marker of antibody-mediated rejection (ABMR) in kidney allografts, although cellular rejection also have C4d deposits. OBJECTIVE: To correlate C4d expression with clinico-pathological parameters and graft outcomes at three years. METHODS: One hundred forty six renal transplantation recipients with graft biopsies by indication were included. C4d staining was performed by paraffin-immunohistochemistry. Graft function and survival were measured, and predictive variables of the outcome were determined by multivariate Cox regression. RESULTS: C4d staining was detected in 48 (31%) biopsies, of which 23 (14.7%) had diffuse and 25 (16%) focal distribution. Pre-transplantation panel reactive antibodies (%PRA) class I and II were significantly higher in C4d positive patients as compared to those C4d negative. Both glomerulitis and pericapillaritis were associated to C4d (p = 0.002 and p < 0.001, respectively). The presence of C4d in biopsies diagnosed as no rejection (NR), acute cellular rejection (ACR) or interstitial fibrosis/ tubular atrophy (IF/TA) did not impact graft function or survival. Compared to NR, ACR and IF/TA C4d-, patients with ABMR C4d+ had the worst graft survival over 3 years (p = 0.034), but there was no difference between ABMR versus NR, ACR and IF/TA that were C4d positive (p = 0.10). In Cox regression, graft function at biopsy and high %PRA levels were predictors of graft loss. CONCLUSIONS: This study confirmed that C4d staining in kidney graft biopsies is a clinically useful marker of ABMR, with well defined clinical and pathological correlations. The impact of C4d deposition in other histologic diagnoses deserves further investigation

Topics: Transplante de rim, Complemento Cd4, Sobrevivência de enxerto, Rejeição de enxerto, Rejeição humoral, Diseases of the genitourinary system. Urology, RC870-923, Specialties of internal medicine, RC581-951, Internal medicine, RC31-1245, Medicine, R
Publisher: Sociedade Brasileira de Nefrologia
Year: 2011
DOI identifier: 10.1590/S0101-28002011000300009
OAI identifier: oai:doaj.org/article:06e79de1b4104c57806d10edf6fc586e
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