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APOL1-risk alleles modulate T-cell receptor signaling to promote allograft rejection.

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Back-table intra-arterial administration of C1 esterase inhibitor to deceased donor kidney allografts improves posttransplant allograft function: Results of a randomized double-blind placebo-controlled clinical trial.

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Updated: May 6, 2026

In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients
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Transplantation: Complementing donor-specific antibody testing.

Kathryn J Tinckam1, Peter S Heeger

  • 1Department of Laboratory Medicine and Pathobiology, University Health Network HLA Laboratory, University of Toronto, 67 College Street, Room 301, Toronto, ON M5G 2M1, Canada.

Nature Reviews. Nephrology
|November 6, 2013
PubMed
Summary
This summary is machine-generated.

Kidney transplant recipients with donor-specific antibodies that bind C1q show the worst outcomes. Further research is needed before C1q binding assays become standard care in kidney transplantation.

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Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • Donor-specific antibodies (DSAs) are a major cause of kidney transplant failure.
  • Complement activation, particularly via the classical pathway involving C1q, is implicated in antibody-mediated rejection.

Purpose of the Study:

  • To investigate the clinical significance of C1q-binding donor-specific antibodies in kidney transplant recipients.
  • To determine if C1q binding is associated with poorer graft survival.

Main Methods:

  • Analysis of serum samples from kidney transplant recipients for the presence of donor-specific antibodies.
  • Detection of C1q binding capacity of these antibodies.
  • Correlation of C1q-binding antibody status with clinical outcomes, including graft survival and rejection episodes.

Main Results:

  • Kidney transplant recipients whose serum contained donor-specific antibodies capable of binding C1q exhibited significantly worse clinical outcomes.
  • The presence of C1q-binding DSAs was associated with inferior graft survival rates.

Conclusions:

  • C1q-binding donor-specific antibodies may represent a marker of high immunologic risk in kidney transplantation.
  • While these findings are significant, further investigation is required before incorporating C1q binding assays into routine clinical practice for kidney transplant recipients.