Capillary C4d and Kidney Allograft Outcome in Relation to Morphologic Lesions Suggestive of Antibody-Mediated Rejection

• DOI: 10.2215/cjn.09901014
• Publication Date: 2015-06-13T03:06:16Z
• Authors: Željko Kikić; Alexander Kainz; Nicolas Kozakowski; Rainer Oberbauer; Heinz Regele; Gregor Bond; Georg A. Böhmig
• Keywords: Interquartile range; Peritubular capillaries

Background and objectives Recent studies highlighting a role of C4d− antibody-mediated rejection (ABMR) have debated whether C4d staining has independent value as marker. Considering the presumed complement an important effector graft injury, this study hypothesized that capillary C4d, footprint antibody-triggered activation, indicates particularly severe manifestation ABMR. Design, setting, participants, & measurements This large retrospective clinicopathologic sought to assess clinical predictive in relation ABMR morphology. Overall, 885 renal allograft recipients who underwent transplantation between 1999 2006 (median duration follow-up, 63.3 [interquartile range, 40.6–93.5] months; 206 losses) were included if they had one or more indication biopsies. A total 1976 biopsy specimens reevaluated for (C4d data available 825 patients) distinct morphologic lesions suggestive ABMR, including glomerulitis, peritubular capillaritis, microthrombi, transplant glomerulopathy, intimal arteritis. Results C4d+ patients, with without features, worse death-censored 8-year survival (53% 67%) than patients (66% 81%; P<0.001). In Cox regression analysis, was associated risk loss independently baseline confounders morphology (hazard ratio, 1.85 [95% confidence interval, 1.34 2.57]; The higher observed finding reached statistical significance showing fewer two different lesions. Moreover, mixed model, steeper decline eGFR (slope per year, −8.23±3.97 ml/min 1.73 m2; Conclusions These results suggest detection intragraft activation strong additional indicator adverse kidney outcomes.