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

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Abstract

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
Volume2
Issue number6
DOIs
StatePublished - Nov 1 2007

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ASJC Scopus subject areas

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

Cite this

Akalin, E., Dinavahi, R., Dikman, S., de Boccardo, G., Friedlander, R., Schroppel, B., Sehgal, V., Bromberg, J. S., Heeger, P., & Murphy, B. (2007). Transplant glomerulopathy may occur in the absence of donor-specific antibody and C4d staining. Clinical Journal of the American Society of Nephrology, 2(6), 1261-1267. https://doi.org/10.2215/CJN.02420607