C1q binding is not an independent risk factor for kidney allograft loss after an acute antibody‐mediated rejection episode: a retrospective cohort study |
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| Authors: | Anissa Moktefi Juliette Parisot Dominique Desvaux Florence Canoui‐Poitrine Isabelle Brocheriou Julie Peltier Vincent Audard Tomek Kofman Caroline Suberbielle Philippe Lang Eric Rondeau Philippe Grimbert Marie Matignon |
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| Affiliation: | 1. APHP (Assistance Publique‐H?pitaux de Paris), Pathology Department, Groupe Hospitalier Henri‐Mondor/Albert Chenevier, Créteil, France;2. DHU (Département Hospitalo‐Universitaire) VIC (Virus‐Immunité‐Cancer), IMRB (Institut Mondor de Recherche Biomédicale), Equipe 21, INSERM U 955, Université Paris‐Est‐Créteil (UPEC), Créteil, France;3. AP‐HP (Assistance Publique‐H?pitaux de Paris), Public Health Department, Groupe Hospitalier Henri‐Mondor/Albert Chenevier, Créteil, France;4. DHU (Département Hositalo‐Universitaire) A‐TVB, IMRB (Institut Mondor de Recherche Biomédicale)‐ EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris‐Est‐Créteil, UPEC, Créteil, France;5. AP‐HP (Assistance Publique‐H?pitaux de Paris), Pathology Department, Tenon Hospital, Paris, France;6. INSERM UMRS_1155, Université Pierre et Marie Curie, Paris, France;7. AP‐HP (Assistance Publique‐H?pitaux de Paris), Intensive Care Nephrology and Renal Transplantation, Tenon Hospital, Paris, France;8. AP‐HP (Assistance Publique‐H?pitaux de Paris), Nephrology and Renal Transplantation Department, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri‐Mondor/Albert‐Chenevier, Créteil, France;9. AP‐HP (Assistance Publique‐H?pitaux de Paris), Immunology and Histocompatibility Department, Saint Louis Hospital, Paris, France;10. AP‐HP, CIC‐BT 504, Créteil, France |
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| Abstract: | 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. |
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| Keywords: | allograft survival antibody‐mediated rejection C1q‐binding DSA C4d staining kidney transplantation |
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