{
  "abstract": "Introduction\n\nC4d deposition is common after ABO-incompatible (ABOi) kidney transplantation and, unlike ABO-compatible grafts, is not necessarily indicative of antibody-mediated injury.Methods\n\nBetween 2015 and 2022, 254 ABOi kidney transplantations were performed at our center, and 69 recipients with paired 3-month and 1-year protocol biopsies were classified as persistently C4d-positive (n = 54) or C4d-negative/nonpersistent (n = 15). Pre-transplant background, cellular infiltration, chronic Banff lesions according to the Banff 2019 classification, graft function, and graft survival were compared.Results\n\nBaseline anti-A/B titers, ABO combination, donor age, and donor relationship did not differ between the groups, whereas donor sex differed significantly (P = 0.014). Microvascular inflammation, defined as glomerulitis plus peritubular capillaritis ≥2, was observed in 6/54 recipients (11.1%) versus 1/15 (6.7%), and chronic changes, defined as interstitial fibrosis score ≥1, were observed in 27/54 (50.0%) versus 6/15 (40.0%); none of these differences reached statistical significance. Graft function and survival also did not differ significantly, although all four graft losses occurred in the persistent C4d-positive group. Three of these losses were attributable to chronic active antibody-mediated rejection, diagnosed at the 1-year biopsy in one recipient and later in two recipients.Discussion\n\nGiven the selected cohort and limited statistical power, these findings represent a failure to detect an association rather than evidence of equivalence. They are consistent with accommodation but require confirmation in larger, less-selected cohorts.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan.",
    "Department of Organ Transplant Medicine, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yu Kijima"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Hideki Ishida"
    },
    {
      "affs": [
        0
      ],
      "name": "Takafumi Yagisawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Toshihito Hirai"
    },
    {
      "affs": [
        1
      ],
      "name": "Kohei Unagami"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Tomokazu Shimizu"
    },
    {
      "affs": [
        0
      ],
      "name": "Toshio Takagi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0492e143rh2fx.bib",
  "cited_by": 0,
  "doi": "10.3389/fneph.2026.1940137",
  "fulltext_url": "https://europepmc.org/articles/PMC13680244",
  "id": "0492e143rh2fx",
  "issns": [
    "2813-0626"
  ],
  "landing_url": "https://europepmc.org/article/MED/42903221",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2747|Renal Transplantation Outcomes and Treatments"
    ]
  ],
  "openalex": "W7220663769",
  "pdf_url": "https://europepmc.org/articles/PMC13680244?pdf=render",
  "pmcid": "PMC13680244",
  "pmid": "42903221",
  "published": "2026-10-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0492e143rh2fx.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42903221",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42903221"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2747|Renal Transplantation Outcomes and Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Clinical significance of persistent C4d deposition on sequential protocol biopsies in ABO-incompatible kidney transplantation.",
  "title_text": "Clinical significance of persistent C4d deposition on sequential protocol biopsies in ABO-incompatible kidney transplantation.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/0492e143rh2fx",
  "venue": "Frontiers in nephrology",
  "versions": []
}