Early Antibody-Mediated Rejection C4d Status Remains a Marker of Prognosis in HLA-Incompatible Kidney Transplantation.
1CHP, Porto, Portugal
2IPST, Porto, Portugal
Meeting: 2017 American Transplant Congress
Abstract number: A12
Keywords: Alloantibodies, Histology, Kidney transplantation, Rejection
Session Information
Session Name: Poster Session A: Antibody Mediated Rejection in Kidney Transplant Recipients I
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Banff criteria for the diagnosis of antibody-mediated rejection (AMR) in kidney transplantation (KT) was recently updated to include the entity of C4d negative AMR, if moderate microvascular inflammation (MVI, g+ptc≥2) is detectable. Nevertheless, its clinical impact in the setting of early AMR remains unclear.
Thirty recipients experiencing early AMR after HLA-incompatible KT were studied. Median days to AMR: 13 (IQR 9-31). C4d was detected in frozen tissue samples by immunofluorescence. We aimed to analyze the relationship between C4d status, DSA and other histological characteristics. Furthermore, we sought to evaluate the impact of AMR C4d status, C4d and MVI Banff scores in graft survival.
Comparison of clinical characteristics according to AMR C4d status
| C4d – (n =13) | C4d + (n=17) | P | |
| Previous KT, % | 39 | 59 | 0.269 |
| HLA mismatch, mean | 3.92 | 4.18 | 0.678 |
| Peak PRA, median | 24 | 50 | 0.165 |
| ATG induction, % | 69 | 77 | 0.698 |
| Pre-KT Desensitization with PP+IvIg, % | 23 | 41 | 0.440 |
| Pre-KT Desensitization with PP+IvIg+Rituximab, % | 15 | 29 | 0.427 |
| DSA I, % | 85 | 71 | 0.427 |
| DSA II, % | 62 | 77 | 0.443 |
| DSA number, median | 2 | 3 | 0.180 |
| Days to AMR, median | 12 | 11 | 0.526 |
| AMR treatment with PP+IvIg±Rituximab, % | 31 | 100 | <0.001 |
Censored graft survival curves according to AMR C4d status, C4d and MVI Banff scores 
C4d+ AMR was associated with stronger and C1q-binding DSA. It correlated significantly with MVI scores. However, graft survival was significantly lower in patients experiencing C4d+ AMR, while AMR defining MVI score was not. C4d remains a powerful marker of prognosis in early AMR.
CITATION INFORMATION: Malheiro J, Santos S, Tafulo S, Dias L, Martins L, Ramon J, Castro-Henriques A. Early Antibody-Mediated Rejection C4d Status Remains a Marker of Prognosis in HLA-Incompatible Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Malheiro J, Santos S, Tafulo S, Dias L, Martins L, Ramon J, Castro-Henriques A. Early Antibody-Mediated Rejection C4d Status Remains a Marker of Prognosis in HLA-Incompatible Kidney Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/early-antibody-mediated-rejection-c4d-status-remains-a-marker-of-prognosis-in-hla-incompatible-kidney-transplantation/. Accessed May 11, 2025.« Back to 2017 American Transplant Congress