부산대학교 도서관

After kidney transplantation, C4d is an incomplete marker of acute antibody-mediated rejection ( AMR) and C1q-binding donor-specific antibodies ( DSA) have been associated with allograft survival. However, the impact on allograft survival of C1q+ DSA after clinical AMR has not been studied yet. We analysed retrospectively in clinical AMR C4d staining and C1q-binding impact on allograft survival. We compared clinical, histological and serological features of C4d− and C4d+ AMR, C1q+ and C1q− DSA AMR and analysed C4d and C1q-binding impact on allograft survival. Among 500 for-cause kidney allograft biopsies, 48 fulfilled AMR criteria. C4d+ AMR [ N = 18 (37.5%)] have significantly higher number class I DSA ( P = 0.02), higher microvascular score ( P = 0.02) and more transplant glomerulopathy ( P = 0.04). C1q+ AMR [ N = 20 (44%)] presented with significantly more class I and class II DSA ( P = 0.005 and 0.04) and C4d+ staining ( P = 0.01). Graft losses were significantly higher in the C4d+ group ( P = 0.04) but similar in C1q groups. C4d+ but not C1q+ binding was an independent risk factor for graft loss [ HR = 2.65; (1.11-6.34); P = 0.028]. In our cohort of clinical AMR, C4d+ staining but not C1q+ binding is an independent risk factor for graft loss. Allograft loss and patient survival were similar in C1q+ and C1q− AMR. [ABSTRACT FROM AUTHOR]