The Impact of C4d Pattern and Donor-Specific Antibody on Graft Survival in Recipients Requiring Indication Renal Allograft Biopsy

Clinical and pathological correlations of C4d immunostaining and its infl uence on the outcome of kidney transplant recipients

“…Magil et al 2,26 showed a similar clinical course and biopsy findings in patients with focal or diffuse C4d. Haririan et al 4 also demonstrated that graft survival was adversely influenced by C4d independent of the staining pattern, and focal C4d was a significant independent predictor of graft failure. In our study, patients with focal C4d had the lowest eGFR and graft survival at last follow-up, but this group had either an increased prevalence of DGF and a trend to more deceased donors as graft source, both potentially related to this worse outcome ( Table 2).…”

“…There are consistent data showing DSA as predictive of worse graft function and outcome, 3,22,30 irrespective of C4d staining at least in the first year of transplant. 4 DSA were not measured in our centre when these biopsies were carried out, so we should call ABMR as "presumptive antibody-mediated rejection" based only in C4d positivity and pathologic features.…”

“…6 Staining for C4d in peritubular capillaries is present in other histological diagnosis of kidney graft biopsies, such as acute cellular rejection and/or acute graft injury, 3 interstitial fibrosis and tubular atrophy, calcineurin inhibitor toxicity, and even in grafts without dysfunction and with no morphological signs of rejection. 3,4,7 The influence of C4d on graft function and outcome over these different Banff categories is still unclear.…”

“…[1][2][3][4][5] C4d represents one criterion to the diagnosis of acute and chronic ABMR according to Banff classification. 6 Staining for C4d in peritubular capillaries is present in other histological diagnosis of kidney graft biopsies, such as acute cellular rejection and/or acute graft injury, 3 interstitial fibrosis and tubular atrophy, calcineurin inhibitor toxicity, and even in grafts without dysfunction and with no morphological signs of rejection.…”

C4d/CD34 double-immunofluorescence staining of renal allograft biopsies for assessing peritubular capillary C4d positivity

“…Some studies suggest that even focal C4d staining may have significant clinical ramifications, while other studies fail to show such outcomes. [2][3][4][5] Nevertheless, the data are limited and further evaluation with regard to long-term graft survival is needed.…”