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Positive C4d in kidney transplantation biopsy: clinical impact
1Colombiana de Trasplantes, Departament: Kidney Transplant Service, Bogotá, Colombia.
Insights
In Colombian kidney transplant patients, positive C4d staining in biopsies was linked to panel reactive antibodies and longer time to rejection. This finding impacts understanding antibody-mediated rejection risks.
Area of Science:
- Nephrology
- Transplant Immunology
- Pathology
Background:
- C4d deposition in renal allografts typically indicates antibody-mediated rejection.
- The clinical significance of C4d in Colombian kidney transplant recipients experiencing acute rejection is not well-defined.
- Understanding C4d's association with acute rejection and its impact on graft outcomes is crucial.
Purpose of the Study:
- To investigate the risk factors associated with positive C4d staining in kidney transplant biopsies during acute cellular rejection episodes.
- To analyze the relationship between C4d positivity and clinical parameters in Colombian kidney transplant patients.
Main Methods:
- Retrospective review of 226 kidney transplant biopsies exhibiting acute rejection, classified by Banff 2009 criteria.
- Biopsies were collected between January 2005 and December 2012 due to graft dysfunction.
- C4d deposition was assessed using immunohistochemistry.
Main Results:
- C4d staining was positive in 25 out of 226 evaluated biopsies (11.1%).
- Patients with positive C4d staining experienced a longer average rejection time (15 months) compared to those with negative staining (8 months).
Conclusions:
- Positive panel reactive antibodies and increased time between transplantation and rejection were identified as significant risk factors for C4d positivity.
- Other analyzed variables did not show a significant relationship with C4d expression in this cohort.
Background:
Deposition of C4d in peritubular capillaries of renal graft is normally associated with the presence of antibody-mediated rejection. The clinical impact of its presence in patients with renal transplant in Colombia is uncertain, as well as the association in acute rejection and the response to the management and survival of the graft. The aim of this study was to determine the risk of having positive C4d in biopsies of patients with episodes of acute cellular rejection.
Methods:
We retrospectively reviewed 226 biopsies of kidney transplantation, all of them with acute rejection and histopathological findings classified according to Banff criteria 2009 and performed between January 2005 and December 2012 for graft dysfunction. C4d staining was performed by immunohistochemistry.
Results:
C4d staining was positive in 25 of 226 biopsies. Rejection time in patients with positive C4d was 15 months in average vs 8 months with negative C4d.
Conclusions:
With the use of a multivariate analysis, we found that the unique risk for C4d in our population was the positive panel reactive antibodies and elapsed time between transplant and the rejection (odds ratio: 2.12, P = .034) and that the other variables analyzed are not related to the expression of C4d.
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