Document Detail

Transplant glomerulopathy may occur in the absence of donor-specific antibody and C4d staining.
MedLine Citation:
PMID:  17942771     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Transplant glomerulopathy (TGP) has been proposed to be a component of chronic antibody-mediated rejection (AMR). We have studied 36 patients with TGP and 51 patients with chronic allograft nephropathy (CAN) but without TGP for C4d staining and donor-specific anti-HLA antibodies (DSA) to investigate the alloantibody-mediated mechanisms. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Allograft biopsies were stained with C4d staining and DSAs were studied by Luminex Flow Beads. Allograft biopsies were done at a mean of 5.3 +/- 5.0 and 5.6 +/- 4.6 yr after transplantation in patients with CAN and TGP, respectively. RESULTS: The mean creatinine level at the time of the biopsy was 2.7 +/- 1.2 mg/dl in each group. Proteinuria of >1.0 g/d was more common in patients with TGP (61 versus 25%; P = 0.002). Whereas three patients with TGP had a history of acute AMR, none of the patients with CAN had. Mean chronicity score of the biopsies were 1.7 +/- 0.7 in patients with CAN and 1.9 +/- 0.8 in patients with TGP. Biopsies from only two (4%) patients with CAN and four (11%) patients with TGP had diffuse C4d positivity. DSA were found in 36% of TGP and 33% of CAN patients. CONCLUSIONS: These results suggest that a substantial number of patients with TGP did not have positive C4d staining or DSA, indicating that a non-alloantibody-mediated process may be involved in the development of TGP in some patients.
Enver Akalin; Rajani Dinavahi; Steven Dikman; Graciela de Boccardo; Rex Friedlander; Bernd Schroppel; Vinita Sehgal; Jonathan S Bromberg; Peter Heeger; Barbara Murphy
Publication Detail:
Type:  Journal Article     Date:  2007-10-17
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  2     ISSN:  1555-905X     ISO Abbreviation:  -     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-26     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1261-7     Citation Subset:  IM    
Renal Division, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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MeSH Terms
Chronic Disease
Complement C4b / analysis*
Graft Rejection / etiology*,  immunology,  pathology
HLA Antigens / immunology*
Isoantibodies / blood*
Kidney Glomerulus / pathology*
Kidney Transplantation / adverse effects*
Middle Aged
Peptide Fragments / analysis*
Staining and Labeling
Tissue Donors*
Transplantation, Homologous
Reg. No./Substance:
0/HLA Antigens; 0/Isoantibodies; 0/Peptide Fragments; 80295-50-7/Complement C4b; 80295-52-9/complement C4d
Comment In:
Clin J Am Soc Nephrol. 2007 Nov;2(6):1108-9   [PMID:  17942764 ]

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