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Peritubular capillary C4d deposition and renal outcome in post‐transplant IgA nephropathy
Author(s) -
Choi Jung,
Cho Yong Mee,
Yang Won Seok,
Park TaeJin,
Chang Jai Won,
Park SuKil
Publication year - 2007
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2007.00487.x
Subject(s) - peritubular capillaries , medicine , azotemia , biopsy , nephropathy , pathology , transplantation , kidney transplantation , kidney , renal biopsy , renal function , immunohistochemistry , gastroenterology , proteinuria , urology , endocrinology , diabetes mellitus
Backgrounds: Immunological staining of the transplanted kidney for C4d in peritubular capillaries (C4d PTC ) has emerged as a useful method to detect antibody‐mediated rejection in situ . In this retrospective study, we evaluated the prevalence of C4d PTC deposition in allograft renal biopsies diagnosed of IgA nephropathy (IgAN) and analysed its clinical significance. Method: Sixty‐six biopsy specimens of post‐transplant IgAN, which were obtained to evaluate azotemia and/or heavy proteinuria, were examined by immunohistochemical staining of the paraffin sections with polyclonal antibody for C4d. Results: C4d was stained positively in peritubular capillaries in 16 (24%) of the 66 cases. The C4d PTC ‐negative (n=50) and C4d PTC ‐positive groups (n=16) were not different in recipient gender, age, donor age, type of donor (living vs. cadaveric), interval from transplantation to graft biopsy (41.6± 21.8 vs. 48.3±26.1 months) and post‐biopsy follow‐up period (60.3±23.3 vs. 56.9±25.4 months). During the follow‐up period, 12 of 50 (24%) although the incidence of graft failure was not different by the C4d deposition in peritubular capillaries, intervals from renal biopsy to graft failure tended to be shorter in C4d PTC ‐positive cases than C4d PTC ‐negative cases. In Kaplan–Meier analysis, the renal allograft function of the C4d PTC ‐positive group deteriorated more rapidly than that of the C4d PTC ‐negative group (p<0.05). Histologically, the C4d PTC ‐positive group had findings suggestive of acute cellular rejection more commonly than the C4d PTC ‐negative group (p<0.01). Conclusions: Evidence of humoral rejection, as demonstrated by C4d PTC deposition, was concurrently present in significant portions of post‐transplant IgAN biopsy specimens and was associated with more rapid deterioration of renal function. These results suggest that C4d PTC positivity needs to be determined at the time of biopsy even in cases of post‐transplant glomerulonephritis and immunosuppression may need to be modified accordingly.