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Updated: Jul 7, 2026
Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Renal allograft C4d deposition in Chinese: Hong Kong perspective
Sze K Yuen1, Yuen F Mak, Hon L Tang
1Department of Medicine and Geriatrics, ICU, Caritas Medical Centre, Hong Kong. yuenskit@yahoo.com.hk
Insights
Peritubular capillary C4d deposition is a key indicator of humoral rejection in kidney transplants. This study confirms C4d positivity independently predicts graft failure in Chinese patients, highlighting its prognostic value.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Acute rejection significantly contributes to renal allograft loss.
- Peritubular capillary C4d deposition is a marker for humoral alloimmunity and rejection.
- C4d presence in biopsies is a critical risk factor for graft failure, with limited data in Chinese subjects.
Purpose of the Study:
- To investigate the prognostic value of peritubular capillary C4d deposition in Chinese renal transplant recipients.
- To assess the association between C4d positivity and renal allograft outcomes.
Main Methods:
- Retrospective review of 52 renal graft biopsies performed between 2002 and 2006 for acute dysfunction or delayed graft function.
- Assessment of renal outcomes and survival at multiple time points post-biopsy using Kaplan-Meier analysis.
- Multivariate analysis to determine if C4d positivity is an independent predictor of poor renal outcome.
Main Results:
- 16 out of 52 biopsies were positive for peritubular capillary C4d.
- C4d positivity correlated with reduced glomerular filtration rate and elevated serum creatinine at 6 and 12 months.
- C4d-positive recipients experienced worse outcomes, including death-censored graft failure and significant decline in renal function.
Conclusions:
- Peritubular capillary C4d staining is confirmed as an independent prognostic factor for renal allograft survival in the Chinese population.
- C4d deposition serves as a valuable biomarker for predicting graft failure in kidney transplantation.
Background:
Acute rejection constitutes a significant proportion of renal allograft loss. Peritubular capillary deposition of C4d has been recognized as the footprint of humoral alloimmunity and proven to be a sensitive and specific marker for humoral rejection in the appropriate clinical context. Its presence in indication biopsies is the most important independent risk factor for graft failure. Data are, however, scarce among Chinese subjects.
Methods:
We retrospectively reviewed all renal graft biopsies performed from 1 April 2002 to 31 March 2006 for unexplained acute renal dysfunction or delayed graft function. Renal outcomes were assessed at the time of renal biopsy and at 1 month, 3 months, 6 months and 1 year afterwards. Survival was assessed by Kaplan-Meier analysis. Multivariate analysis was used to determine if C4d positivity is an independent risk factor for poor renal outcome.
Results:
Fifty-two biopsies were included, of which 16 were positive for peritubular capillary C4d. Peritubular capillary C4d was associated with lower glomerular filtration rate and higher serum creatinine at 6 and 12 months after renal biopsies. The C4d-positive group fares worse in terms of death-censored graft failure, doubling of serum creatinine and reaching 50% of glomerular filtration rate at the end of the study. Peritubular capillary C4d deposition was the only significant risk factor that predicts graft failure in multivariate analysis.
Conclusion:
Our findings confirmed the independent prognostic value of peritubular capillary C4d staining on renal allograft survival in Chinese.
