J Korean Soc Transplant.  2005 Dec;19(2):137-141.

Clinical Significance of C4d-Positivity in Renal Transplant Recipients with Acute Rejection

• Chung BH
• Jung HS
• Jeon SH
• Park YJ
• Choi SO
• Yoon JM
• Choi BS
• Choi YJ
• Yang CW
• Kim YS
• Kang CS
• Bang BK

Abstract

PURPOSE
C4d detection in peritubular capillaries in acute allograft rejection has been regarded as a poor prognostic factor for graft kidney survival. We investigated the clinical importance of C4d positivity in renal transplant recipients with acute rejection.
METHODS
Forty eight renal allograft biopsies were selected, which were available for immunofluorescence study. The samples were divided into two groups, one which was diagnosed as acute rejection clinically (n=30), the other which underwent protocol biopsy 2 weeks after transplantation (n=18). Among the acute rejection group, C4d staining was positive in 50% of acute rejection cases (C4d (+), n=15) and negative in the others. (C4d (-), n=15). We compared the C4d (+) group and the C4d (-) group in terms of clinical parameters and graft survival duration.
RESULTS
Renal function was reduced in the C4d (+) group compared to the C4d (-) group. In the C4d (+) group, 8 of 15 cases resulted in graft loss, but only one graft loss developed in the C4d (-) group. Graft survival duration after kidney biopsy was reduced in the C4d (+) group compared to the C4d (-) group.
CONCLUSION
Renal transplant recipient with C4d-positive acute rejection shows inferior graft survival duration. So tight management in addition to steroid pulse therapy should be considered for these patients.

Keyword

Acute allograft rejection; C4d; Kidney transplantation

MeSH Terms

Allografts
Biopsy
Capillaries
Fluorescent Antibody Technique
Graft Survival
Humans
Kidney
Kidney Transplantation
Transplantation*
Transplants