Focal C4d Staining in Biopsies of Kidney Transplant Recipients Is Not Associated with Antibody Mediated Rejection and Does Not Correlate with Graft Survival.
Transplant Institute, Henry Ford Hospital, Detroit, MI.
Meeting: 2016 American Transplant Congress
Abstract number: D12
Keywords: Antibodies, HLA antibodies, Rejection
Session Information
Session Name: Poster Session D: Antibody Mediated Rejection: Session #2
Session Type: Poster Session
Date: Tuesday, June 14, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction: While diffuse C4d positivity in kidney transplant peritubular capillaries(PTC) strongly co-relates with the presence of antibody mediated rejection(AMR),data on the significance of focal C4d deposits are lacking.The effect of DGF, anti-HLA DSA and high PRA on C4d staining remains uncertain.We present our center's experience of C4d staining in kidney transplant biopsies
Methods: All consecutive biopsies in kidney transplant recipients done at our institution between December 2011 and March 2013 were retrospectively reviewed.C4d was assessed by immunohistochemistry and histopathological examination.Biopsies were classified as PTC C4d negative(<10%),focal(10%-50%)or diffuse(>50%).AMR and Cell Mediated Rejection(CMR) were diagnosed using Banff criteria
Results: Patient characteristics
| Characteristic | Value (N=100) |
| Mean age(y) | 53+/-15 |
| Sex | 65% M |
| Race | 66%AA |
| cPRA(%) |
56% No PRA Mean cPRA=16.9+/-28.3 |
| Decesaed Donors | 73% |
| Mean time after transplant to biopsy(d) | 747+/-1093 |
Follow up was a mean of 646 +/- 273 days.Out of 100 biopsies,58% were C4d negative,33% focal C4d,9% were diffuse C4d positive.While 6/9 patients with diffuse C4d had AMR,no patients with negative or focal C4d had AMR.CMR was diagnosed in 5/9 patients with diffuse C4d and the incidence of CMR was 24% and 29% in focal or no C4d biopsies.(statistically insignificant).While graft loss was 55% in diffuse C4d biopsies, there was no statistically significant difference between incidence of graft loss in focal positive(25%) and C4d negative(31%) biopsies.There was no statistically significant difference between C4d positivity in patients with or without DGF.We found no statistically significant difference in C4d positivity in patients with low(<30%) vs high cPRA(>30%). Summary of DSA :
| DSA |
C4d negative N=57 |
C4d positive (focal+diffuse)N=41 |
| None | 46/98 (47%) | 24/98(24%) |
|
Class 1 N=7 |
2/98(2%) | 5/98(5%) |
| Class 2 N=16 | 8/98(8%) | 8/98(8%) |
| Class 1+2 N=5 | 1/98(1%) |
4/98(4%) |
|
Information on DSA missing in 2 patients . Trend towards significance for C4d positivity in patients with DSA vs no DSA |
|
Conclusion: Our data suggest no implication of focal C4d in PTC in kidney transplant biopsies in diagnosis of AMR, CMR or incidence of graft loss.Additionally,high cPRA and DGF appear to have no association with C4d positivity in kidney transplant biopsies.
CITATION INFORMATION: Prashar R, Goggins M, Yessayan L, Patel A, Goggins M. Focal C4d Staining in Biopsies of Kidney Transplant Recipients Is Not Associated with Antibody Mediated Rejection and Does Not Correlate with Graft Survival. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Prashar R, Goggins M, Yessayan L, Patel A, Goggins M. Focal C4d Staining in Biopsies of Kidney Transplant Recipients Is Not Associated with Antibody Mediated Rejection and Does Not Correlate with Graft Survival. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/focal-c4d-staining-in-biopsies-of-kidney-transplant-recipients-is-not-associated-with-antibody-mediated-rejection-and-does-not-correlate-with-graft-survival/. Accessed May 21, 2025.« Back to 2016 American Transplant Congress