C4d deposition in allografts: current concepts and interpretation |
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| Institution: | 1. Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India;2. Radiation Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India;3. Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India;1. Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, PO Box 6108, Morgantown, WV 26506, United States;2. National Center for Cool and Cold Water Aquaculture, ARS/USDA, 11861 Leetown Road, Kearneysville, WV 25430, United States;1. Transplantation Research Institute, Seoul National University College of Medicine, Republic of Korea;2. Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea;3. Institute of Green Bio Science and Technology, Seoul National University, Republic of Korea;4. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea;5. Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Republic of Korea;6. Graduate School of Medicine, Korea University, Republic of Korea;7. Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea;1. Department of Neuroscience, Graduate School, Kyung Hee University, Republic of Korea;2. Department of Physiology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea;3. Neurodegeneration Control Research Center, School of Medicine, Kyung Hee University, Seoul, Republic of Korea;4. Department of Biochemistry & Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea;5. School of Nano-Bioscience and Chemical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea;6. School of Life Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea;7. College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea;8. Brain Science Institute-Center for Neuroscience, Korea Institute of Science and Technology, Seoul 136-791, Republic of Korea;9. Department of Neuroscience, Korea University of Science and Technology, Daejeon 305-350, Republic of Korea;10. Convergence Research Center for Diagnosis, Treatment and Care System of Dementia, Korea Institute of Science and Technology, Seoul 136-791, Republic of Korea |
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| Abstract: | Alloantibody responses are not prevented by the latest immunosuppressive regimens and contribute to increased early and late renal allograft graft loss. Numerous papers have set forth the clinical, pathological, and immunopathological features of acute humoral rejection, in particular the strong correlation between the presence of C4d deposition and circulating antidonor HLA class I and class II antibodies. Humoral rejection also occurs in a chronic setting, associated with chronic allograft glomerulopathy and arteriopathy. C4d deposition can also be found in stable grafts without concurrent graft pathology, a finding that may indicate accommodation. The central diagnostic criterion for humoral rejection is the demonstration of C4d in peritubular capillaries. The criteria for humoral rejection are not as widely accepted for other organs, such as the heart, lung, and pancreas, although humoral rejection, including C4d deposition, has been described. This review focuses on the practical aspects of this test, particularly as applied routinely in renal allografts since 1998 in our laboratory. |
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