Clinical significance of persistent C4d deposition on sequential protocol biopsies in ABO-incompatible kidney transplantation.
- 1Department of Urology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan.
- 2Department of Organ Transplant Medicine, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan.
Abstract
Introduction
C4d deposition is common after ABO-incompatible (ABOi) kidney transplantation and, unlike ABO-compatible grafts, is not necessarily indicative of antibody-mediated injury.Methods
Between 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
Baseline 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
Given 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.
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BibTeX
@article{kijima2026clinical,
title = {{Clinical significance of persistent C4d deposition on sequential protocol biopsies in ABO-incompatible kidney transplantation.}},
author = {Yu Kijima and Hideki Ishida and Takafumi Yagisawa and Toshihito Hirai and Kohei Unagami and Tomokazu Shimizu and Toshio Takagi},
journal = {Frontiers in nephrology},
year = {2026},
month = oct,
doi = {10.3389/fneph.2026.1940137},
url = {https://europepmc.org/article/MED/42903221},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical significance of persistent C4d deposition on sequential protocol biopsies in ABO-incompatible kidney transplantation.
AU - Yu Kijima
AU - Hideki Ishida
AU - Takafumi Yagisawa
AU - Toshihito Hirai
AU - Kohei Unagami
AU - Tomokazu Shimizu
AU - Toshio Takagi
PY - 2026
DA - 2026/10/06
JO - Frontiers in nephrology
DO - 10.3389/fneph.2026.1940137
UR - https://europepmc.org/article/MED/42903221
AB - Introduction C4d deposition is common after ABO-incompatible (ABOi) kidney transplantation and, unlike ABO-compatible grafts, is not necessarily indicative of antibody-mediated injury.Methods Between 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 Baseline 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 Given 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.
SN - 2813-0626
ER -