C4d and C3d Staining in Biopsies of ABO- and HLA-Incompatible Renal Allografts: Correlation with Histologic Findings
Article first published online: 8 MAY 2006
American Journal of Transplantation
Volume 6, Issue 8, pages 1829–1840, August 2006
How to Cite
Haas, M., Rahman, M. H., Racusen, L. C., Kraus, E. S., Bagnasco, S. M., Segev, D. L., Simpkins, C. E., Warren, D. S., King, K. E., Zachary, A. A. and Montgomery, R. A. (2006), C4d and C3d Staining in Biopsies of ABO- and HLA-Incompatible Renal Allografts: Correlation with Histologic Findings. American Journal of Transplantation, 6: 1829–1840. doi: 10.1111/j.1600-6143.2006.01356.x
- Issue published online: 8 MAY 2006
- Article first published online: 8 MAY 2006
- Received 12 October 2005, revised 27 February 2006 and accepted for publication 21 March 2006
- antibody-mediated rejection;
- positive crossmatch;
- renal biopsy;
- renal transplantation
Biopsies of ABO-incompatible and positive crossmatch (HLA-incompatible) renal allografts were retrospectively examined to compare results of C4d and C3d staining, and the correlation between such staining and histologic findings suggestive of antibody-mediated rejection (AMR). A total of 75 biopsies (55 protocol, 17 for graft dysfunction, 3 for other indications) of 24 ABO-incompatible grafts and 244 biopsies (103 protocol, 129 for graft dysfunction, 12 for other indications) of 66 HLA-incompatible grafts were examined; all were stained for C4d and ∼40% for C3d.
In ABO-incompatible grafts, 80% of protocol biopsies and 59% performed for graft dysfunction showed C4d staining in peritubular capillaries (PTC); this staining was not correlated with neutrophil margination in PTC. In HLA-incompatible grafts, PTC C4d was present in 26% of protocol biopsies and 60% of biopsies for graft dysfunction; 92% of biopsies with >1+ (0–4+ scale), diffuse PTC C4d had ≥1+ margination and/or thrombotic microangiopathy (TMA), compared with 12% of C4d-negative biopsies. C3d was somewhat more predictive of margination than C4d in ABO-incompatible, but not HLA-incompatible, grafts. In summary, while PTC C4d deposition indicates probable AMR in biopsies of HLA-incompatible grafts, including protocol biopsies, there is no histologic evidence that C4d deposition is correlated with injury in most ABO-incompatible grafts.