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Donor-specific antibodies, glomerulitis, and human leukocyte antigen B eplet mismatch are risk factors for peritubular capillary C4d deposition in renal allografts / 中华医学杂志(英文版)
Chinese Medical Journal ; (24): 2874-2881, 2021.
Article in English | WPRIM | ID: wpr-921192
ABSTRACT
BACKGROUND@#The complement system plays an important role in the immune response to transplantation, and the diagnostic significance of peritubular capillary (PTC) C4d deposition (C4d+) in grafts is controversial. The study aimed to fully investigate the risk factors for PTC C4d+ and analyze its significance in biopsy pathology of kidney transplantation.@*METHODS@#This retrospective study included 124 cases of kidney transplant with graft biopsy and donor-specific antibody (DSA) testing from January 2017 to December 2019 in a single center. The effects of recipient pathological indicators, eplet mismatch (MM), and DSAs on PTC C4d+ were examined using univariate and multivariate logistic regression analyses.@*RESULTS@#In total, 35/124 (28%) were PTC C4d+, including 21 with antibody-mediated rejection (AMR), eight with renal tubular injury, three with T cell-mediated rejection, one with glomerular disease, and two others. Univariate analysis revealed that DSAs (P < 0.001), glomerulitis (P < 0.001), peritubular capillaritis (P < 0.001), and human leukocyte antigen (HLA) B eplet MM (P = 0.010) were the influencing factors of PTC C4d+. According to multivariate analysis, DSAs (odds ratio [OR] 9.608, 95% confidence interval [CI] 2.742-33.668, P < 0.001), glomerulitis (OR 3.581, 95%CI 1.246-10.289, P = 0.018), and HLA B eplet MM (OR 1.166, 95%CI 1.005-1.353, P = 0.042) were the independent risk factors for PTC C4d+. In receiver operating characteristic curve analysis, the area under the curve was increased to 0.831 for predicting PTC C4d+ when considering glomerulitis, DSAs, and HLA B eplet MM. The proportions of HLA I DSAs and PTC C4d+ in active antibody-mediated rejection were 12/17 and 15/17, respectively; the proportions of HLA class II DSAs and PTC C4d+ in chronic AMR were 8/12 and 7/12, respectively. Furthermore, the higher the PTC C4d+ score was, the more serious the urinary occult blood and proteinuria of recipients at the time of biopsy.@*CONCLUSIONS@#PTC C4d+ was mainly observed in AMR cases. DSAs, glomerulitis, and HLA B eplet MM are the independent risk factors for PTC C4d+.
Subject(s)
Full text: Available Index: WPRIM (Western Pacific) Main subject: Peptide Fragments / Biopsy / HLA-B Antigens / Complement C4b / Retrospective Studies / Risk Factors / Kidney Transplantation / Allografts / Graft Rejection / HLA Antigens Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Chinese Medical Journal Year: 2021 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Peptide Fragments / Biopsy / HLA-B Antigens / Complement C4b / Retrospective Studies / Risk Factors / Kidney Transplantation / Allografts / Graft Rejection / HLA Antigens Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Chinese Medical Journal Year: 2021 Type: Article