Transplant glomerulopathy may occur in the absence of donor-specific antibody and C4d staining

Enver Akalin, Rajani Dinavahi, Steven Dikman, Graciela de Boccardo, Rex Friedlander, Bernd Schroppel, Vinita Sehgal, Jonathan S. Bromberg, Peter Heeger, Barbara Murphy

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Background and objectives: Transplant glomerulopathy (TGP) has been proposed to be a component of chronic antibody-mediated rejection (AMR). We have studied 36 patients with TGP and 51 patients with chronic allograft nephropathy (CAN) but without TGP for C4d staining and donor-specific anti-HLA antibodies (DSA) to investigate the alloantibody-mediated mechanisms. Design, setting, participants, & measurements: Allograft biopsies were stained with C4d staining and DSAs were studied by Luminex Flow Beads. Allograft biopsies were done at a mean of 5.3 ± 5.0 and 5.6 ± 4.6 yr after transplantation in patients with CAN and TGP, respectively. Results: The mean creatinine level at the time of the biopsy was 2.7 ± 1.2 mg/dl in each group. Proteinuria of >1.0 g/d was more common in patients with TGP (61 versus 25%; P = 0.002). Whereas three patients with TGP had a history of acute AMR, none of the patients with CAN had. Mean chronicity score of the biopsies were 1.7 ± 0.7 in patients with CAN and 1.9 ± 0.8 in patients with TGP. Biopsies from only two (4%) patients with CAN and four (11%) patients with TGP had diffuse C4d positivity. DSA were found in 36% of TGP and 33% of CAN patients. Conclusions: These results suggest that a substantial number of patients with TGP did not have positive C4d staining or DSA, indicating that a non-alloantibody-mediated process may be involved in the development of TGP in some patients.

Original languageEnglish (US)
Pages (from-to)1261-1267
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Issue number6
StatePublished - Nov 2007
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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