NDT Advance Access published online on January 5, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfk028
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1 Department of Pathology and Laboratory Medicine, St Paul's Hospital, Vancouver, BC, Canada
* To whom correspondence should be addressed. Background. Diffuse peritubular capillary (PTC) C4d deposition has been shown to be associated with relatively poor graft outcome. The significance of focal PTC C4d staining in the early post-transplant period is uncertain. Methods. Sixty-five biopsies from 53 patients with acute rejection were graded (Banff ’97 criteria), stained for C4d, monocytes and T cells, and divided into three groups according to PTC C4d: (i) focal C4d (F) (14 biopsies, 14 patients), (ii) diffuse C4d (D) (23 biopsies, 15 patients) and (iii) no C4d (N) (28 biopsies, 24 patients). The three groups were compared with respect to a variety of biopsy and clinical parameters including outcome. Results. The incidence of transplant glomerulitis and glomerular monocyte infiltration were significantly greater in F (64% and 2.0±2.0) and D (57% and 3.4±2.0) than in N (11% and 0.2±0.2). A significantly higher proportion of F (93%) demonstrated acute cellular rejection (Banff ’97 grade Conclusion. The results suggest that the biopsy findings and clinical course in patients with focal PTC C4d staining are similar to those associated with diffuse C4d.
Received September 12, 2005
Accepted December 7, 2005
Original Article
Focal peritubular capillary C4d deposition in acute rejection
Alexander B. Magil 1 *
and
Kathryn J. Tinckam 2
2 Division of Nephrology, Department of Medicine, St Paul's Hospital, Vancouver, BC, Canada
Alexander B. Magil, E-mail: amagil{at}providencehealth.bc.ca
Abstract 
1A) than did D (35%). The F and D groups included significantly more females (50 and 67%, respectively) than did N (21%). The percentage of patients with a second or third transplant was higher in F (29%) and D (40%) than in N (8%) (P = 0.0589). The proportion of patients with glomerular filtration rate <30 ml/min at 12, 24 and 48 months was higher in the D and F groups than in the N, and there was a statistically significant increasing trend in odds of this outcome occurring at 48 months across the three groups (D>F>N group) (P = 0.0416).
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