C4d positive staining as mandatory in acute antibody-mediated rejection (AMR) is controversial. Predictive prognosis value of C4d positive staining in AMR remains incompletely studied. We conducted a retrospective single-center study to better define C4d- entity and its prognosis value.
Among 1347 renal allograft biopsies performed during 01/2005 and 01/2012 at our center, 35 were included on following criteria: clinically indicated biopsy and first episode of acute AMR defined by DSA detection and morphological changes (Banff 2009). We generated Kaplan-Meier survival curves and performed a multivariable analysis using the Cox proportional hazards regression model to identify risk factors for allograft failure after acute AMR.
Among the 35 patients included, 18 (51%) presented with acute AMR C4d -. Induction therapy included significantly less thymoglobulin in C4d- patients (p=0.01) and they were significantly older (p=0.004) than C4d+ patients. Renal allograft morphological changes were identical in both groups. Kaplan-Meier survival estimates showed that C4d- is associated with graft survival (49 ± 7 months vs. 32 ± 8 months respectively, P=0.04, Mantel-Cox log-rank test). The Cox proportional hazards regression analysis identified that C4d- (hazard ratio, 0.73 [95% confidence interval, 0.06-0.98]; P=0.04) and estimated glomerular filtration rate (hazard ratio, 0.39 [95% confidence interval, 0.20-0.92]; P=0.03) were independent risk factors for allograft loss.
Our single-center study has elucidated, for the first time at our knowledge, that C4d staining in kidney transplant recipients with acute AMR is an independent risk factor for graft failure. Level of allograft dysfunction at the time of diagnosis was also an independent predictor of graft loss. C4d staining merits to be included in therapeutic decision and these results need to be confirmed on a larger cohort.
To cite this abstract in AMA style:Moktefi A, Matignon M, Suberbielle-Boissel C, Charron D, Lang P, Desvaux D, Grimbert P. C4d Staining Is an Independent Risk Factor of Graft Loss for Renal Allograft Failure in Patients with Acute Antibody-Mediated Rejection [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/c4d-staining-is-an-independent-risk-factor-of-graft-loss-for-renal-allograft-failure-in-patients-with-acute-antibody-mediated-rejection/. Accessed September 18, 2021.
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