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Combination of peritubular c4d and transplant glomerulopathy predicts late renal allograft failure.
Title | Combination of peritubular c4d and transplant glomerulopathy predicts late renal allograft failure. |
Publication Type | Journal Article |
Year of Publication | 2009 |
Authors | Kieran, N, Wang, X, Perkins, J, Davis, C, Kendrick, E, Bakthavatsalam, R, Dunbar, N, Warner, P, Nelson, K, Smith, KD, Nicosia, RF, Alpers, CE, Leca, N, Kowalewska, J |
Journal | J Am Soc Nephrol |
Volume | 20 |
Issue | 10 |
Pagination | 2260-8 |
Date Published | 2009 Oct |
ISSN | 1533-3450 |
Keywords | Adult, Biopsy, Complement C4b, Female, Humans, Kidney Diseases, Kidney Glomerulus, Kidney Transplantation, Male, Middle Aged, Peptide Fragments, Proportional Hazards Models, Transplantation, Homologous |
Abstract | The histologic associations and clinical implications of peritubular capillary C4d staining from long-term renal allografts are unknown. We identified 99 renal transplant patients who underwent an allograft biopsy for renal dysfunction at least 10 yr after transplantation, 25 of whom were C4d-positive and 74 of whom were C4d-negative. The average time of the index biopsy from transplantation was 14 yr in both groups. Compared with C4d-negative patients, C4d-positive patients were younger at transplantation (29 +/- 13 versus 38 +/- 12 yr; P < 0.05) and were more likely to have received an allograft from a living donor (65 versus 35%; P < 0.001). C4d-positive patients had more inflammation, were more likely to have transplant glomerulopathy, and had worse graft outcome. The combined presence of C4d positivity, transplant glomerulopathy, and serum creatinine of >2.3 mg/dl at biopsy were very strong predictors of rapid graft loss. C4d alone did not independently predict graft loss. Retrospective staining of historical samples from C4d-positive patients demonstrated C4d deposition in the majority of cases. In summary, these data show that in long-term renal allografts, peritubular capillary staining for C4d occurs in approximately 25% of biopsies, can persist for many years after transplantation, and strongly predicts graft loss when combined with transplant glomerulopathy. |
DOI | 10.1681/ASN.2009020199 |
Alternate Journal | J. Am. Soc. Nephrol. |
PubMed ID | 19729438 |