Acute graft dysfunction after viral enteritis in a patient with cadaveric kidney transplantation: Norovirus infection is a possible cause of linear deposition of C4d in peritubular capillaries of renal allograft

Abstract:  We describe a cadaveric kidney transplant recipient with graft dysfunction after Norovirus infection. The graft biopsy specimen revealed no acute rejection findings, including antibody-mediated rejection in light microscopy. However, immunofluorescent study showed the linear and bright deposition of C4d along peritubular and glomerular capillaries. Norovirus brings formation of infection by binding to the histo-blood group antigens in epithelial cells of small intestine, and uses secretory H-antigen or A-antigen as a receptor. The recipient and donor had blood type A; the virus possibly bound to the histo-blood A-antigen in endothelial cells of vasculature in his graft after viremia. We consider Norovirus infection a possible cause of linear deposition of C4d in peritubular capillaries as a result of activation of complement pathways in endothelial cells of graft vasculature.