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Published ahead of print on October 17, 2007
Clin J Am Soc Nephrol 2: 1261-1267, 2007
© 2007 American Society of Nephrology
doi: 10.2215/CJN.02420607
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Renal Transplantation

Transplant Glomerulopathy May Occur in the Absence of Donor-Specific Antibody and C4d Staining

Enver Akalin*,{dagger}, Rajani Dinavahi*,{dagger}, Steven Dikman{ddagger}, Graciela de Boccardo*,{dagger}, Rex Friedlander§, Bernd Schroppel*,{dagger}, Vinita Sehgal*,{dagger}, Jonathan S. Bromberg{dagger}, Peter Heeger*,{dagger}, and Barbara Murphy*,{dagger}

* Renal Division, {dagger} Recanati/Miller Transplantation Institute, and {ddagger} Department of Pathology, Mount Sinai School of Medicine, and § Immunogenetics Laboratory, Rogosin Institute, New York, New York

Correspondence: Dr. Enver Akalin, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1104, New York, NY 10029-6574. Phone: 212-659-8086; Fax: 212-348-2474; E-mail: enver.akalin{at}msnyuhealth.org

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.


Related Article

Chronic Transplant Glomerulopathy: Need for Further Assessment
Lorraine Racusen
Clin. J. Am. Soc. Nephrol. 2007 2: 1108-1109. [Full Text] [PDF]



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L. Racusen
Chronic Transplant Glomerulopathy: Need for Further Assessment
Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1108 - 1109.
[Full Text] [PDF]


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