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  • Title: C4d deposition in allograft renal biopsies is an independent risk factor for graft failure.
    Author: Wang R, Wang H, Chen J, Wu J, Wang Y, Huang H, He Q.
    Journal: Nephrology (Carlton); 2009 Aug; 14(5):527-32. PubMed ID: 19674321.
    Abstract:
    AIM: Association between C4d deposition and renal allograft survival is still uncertain. We retrospectively evaluated the clinical outcome of C4d deposition in allograft renal biopsies. METHODS: One hundred and fifty biopsies from 150 patients with a histological diagnosis of acute rejection from December 1997 to March 2007 were included. Paraffin-embedded sections were stained with a polyclonal antibody using an immunoperoxidase technique. Detailed clinical data were obtained by retrospective review. RESULTS: C4d was stained positively in 74 (49.3%) of 150 cases: 47 (61.5%) biopsies showed diffuse C4d deposition and 27 (38.5%) showed focal C4d deposition. During follow up, significantly more C4d-positive patients (24/74 patients, 32.4%) lost their grafts, compared with the C4d-negative group (10/76 patients, 13.2%) (P = 0.005). After a Kaplan-Meier analysis, grafts from the C4d-negative group had a markedly higher survival as compared with the C4d-positive group (P = 0.003, log-rank test). Graft survival among C4d-negative, C4d diffuse-positive, and C4d focal-positive groups was significantly different (P = 0.007, log-rank test). The graft survival rate among C4d-negative patients in early (<6 months) and later biopsies (>6 months), and C4d-positive patients in early and in later biopsies was different (P = 0.028, log-rank test). The adjusted risk ratio of graft failure after Cox proportional hazards multivariate analyses for C4d-positive patients was 3.309 (95% confidence interval, 1.413-6.537; P = 0.004). CONCLUSION: Patients with C4d deposition had an inferior graft survival, especially with diffused C4d deposition, and later experienced acute rejection. C4d deposition was an independent risk factor for graft survival.
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