PMID- 34711716
OWN - NLM
STAT- MEDLINE
DCOM- 20211214
LR  - 20220330
IS  - 2542-5641 (Electronic)
IS  - 0366-6999 (Print)
IS  - 0366-6999 (Linking)
VI  - 134
IP  - 23
DP  - 2021 Oct 26
TI  - Donor-specific antibodies, glomerulitis, and human leukocyte antigen B eplet 
      mismatch are risk factors for peritubular capillary C4d deposition in renal 
      allografts.
PG  - 2874-2881
LID - 10.1097/CM9.0000000000001685 [doi]
AB  - BACKGROUND: The complement system plays an important role in the immune response 
      to transplantation, and the diagnostic significance of peritubular capillary 
      (PTC) C4d deposition (C4d+) in grafts is controversial. The study aimed to fully 
      investigate the risk factors for PTC C4d+ and analyze its significance in biopsy 
      pathology of kidney transplantation. METHODS: This retrospective study included 
      124 cases of kidney transplant with graft biopsy and donor-specific antibody 
      (DSA) testing from January 2017 to December 2019 in a single center. The effects 
      of recipient pathological indicators, eplet mismatch (MM), and DSAs on PTC C4d+ 
      were examined using univariate and multivariate logistic regression analyses. 
      RESULTS: In total, 35/124 (28%) were PTC C4d+, including 21 with 
      antibody-mediated rejection (AMR), eight with renal tubular injury, three with T 
      cell-mediated rejection, one with glomerular disease, and two others. Univariate 
      analysis revealed that DSAs (P < 0.001), glomerulitis (P < 0.001), peritubular 
      capillaritis (P < 0.001), and human leukocyte antigen (HLA) B eplet MM 
      (P = 0.010) were the influencing factors of PTC C4d+. According to multivariate 
      analysis, DSAs (odds ratio [OR]: 9.608, 95% confidence interval [CI]: 
      2.742-33.668, P < 0.001), glomerulitis (OR: 3.581, 95%CI: 1.246-10.289, 
      P = 0.018), and HLA B eplet MM (OR: 1.166, 95%CI: 1.005-1.353, P = 0.042) were 
      the independent risk factors for PTC C4d+. In receiver operating characteristic 
      curve analysis, the area under the curve was increased to 0.831 for predicting 
      PTC C4d+ when considering glomerulitis, DSAs, and HLA B eplet MM. The proportions 
      of HLA I DSAs and PTC C4d+ in active antibody-mediated rejection were 12/17 and 
      15/17, respectively; the proportions of HLA class II DSAs and PTC C4d+ in chronic 
      AMR were 8/12 and 7/12, respectively. Furthermore, the higher the PTC C4d+ score 
      was, the more serious the urinary occult blood and proteinuria of recipients at 
      the time of biopsy. CONCLUSIONS: PTC C4d+ was mainly observed in AMR cases. DSAs, 
      glomerulitis, and HLA B eplet MM are the independent risk factors for PTC C4d+.
CI  - Copyright (c) 2021 The Chinese Medical Association, produced by Wolters Kluwer, 
      Inc. under the CC-BY-NC-ND license.
FAU - Zheng, Jin
AU  - Zheng J
AD  - Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, Shaanxi 710061, China.
FAU - Guo, Hui
AU  - Guo H
AD  - Institute of Organ Transplantation, Tongji Hospital affiliated to Tongji Medical 
      College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, 
      China.
FAU - Gong, Hui-Lin
AU  - Gong HL
AD  - Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong 
      University, Xi'an, Shaanxi 710061, China.
FAU - Lan, Ping
AU  - Lan P
AD  - Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong 
      University, Xi'an, Shaanxi 710061, China.
FAU - Ding, Chen-Guang
AU  - Ding CG
AD  - Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, Shaanxi 710061, China.
FAU - Li, Yang
AU  - Li Y
AD  - Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, Shaanxi 710061, China.
FAU - Ding, Xiao-Ming
AU  - Ding XM
AD  - Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, Shaanxi 710061, China.
FAU - Xue, Wu-Jun
AU  - Xue WJ
AD  - Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an 
      Jiaotong University, Xi'an, Shaanxi 710061, China.
LA  - eng
PT  - Journal Article
DEP - 20211026
PL  - China
TA  - Chin Med J (Engl)
JT  - Chinese medical journal
JID - 7513795
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (Peptide Fragments)
RN  - 80295-50-7 (Complement C4b)
SB  - IM
MH  - Allografts
MH  - Biopsy
MH  - Complement C4b
MH  - Graft Rejection
MH  - HLA Antigens
MH  - HLA-B Antigens
MH  - Humans
MH  - *Kidney Transplantation/adverse effects
MH  - Peptide Fragments
MH  - Retrospective Studies
MH  - Risk Factors
PMC - PMC8668015
COIS- None.
EDAT- 2021/10/30 06:00
MHDA- 2021/12/15 06:00
PMCR- 2021/12/05
CRDT- 2021/10/29 05:50
PHST- 2021/10/30 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/10/29 05:50 [entrez]
PHST- 2021/12/05 00:00 [pmc-release]
AID - 00029330-202112050-00016 [pii]
AID - CMJ-2021-011 [pii]
AID - 10.1097/CM9.0000000000001685 [doi]
PST - epublish
SO  - Chin Med J (Engl). 2021 Oct 26;134(23):2874-2881. doi: 
      10.1097/CM9.0000000000001685.