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Presentation and Outcomes of C4d-Negative Antibody-Mediated Rejection After Kidney Transplantation

机译：肾移植后C4d抗体介导的排斥反应的表现及结果

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The updated Banff Classification allows for the diagnosis of antibody-mediated rejection (AMR) in the absence of peritubular capillary C4d staining. Our objective was to quantify allograft loss risk in patients with consistently C4d-negative AMR (n=51) compared to 1)C4d-positive AMR patients (n=156) and, 2)matched controls without AMR. All first year post-transplant biopsies from 1/04–06/14 were reviewed and correlated with the presence of donor-specific antibody (DSA). C4d-negative AMR patients were not different from C4d-positive AMR patients on any baseline characteristics, including immunologic risk factors (PRA, prior transplant, HLA mismatch, donor type, DSA class, and anti-HLA/ABO-incompatibility). C4d-positive AMR patients were significantly more likely to have a clinical presentation (85.3% vs. 54.9%;P<0.001) and those patients presented substantially earlier post-transplant (median 14[IQR 8–32]days vs. 46[IQR 20–191];P<0.001) and was three times more common (7.8% vs 2.5%). One- and 2-year post-AMR-defining biopsy graft survival in C4d-negative AMR patients was 93.4% and 90.2% vs. 86.8% and 82.6% in C4d-positive AMR patients (P=0.4). C4d-negative AMR was associated with a 2.56-fold (95%CI:1.08–6.05; P=0.033) increased risk of graft loss compared to AMR-free matched controls. No clinical characteristics were identified that reliably distinguished C4d-negative from C4d-positive AMR. However, both phenotypes are associated with increased graft loss and thus warrant consideration for intervention.
机译：更新的班夫分类法可在不存在肾小管周围毛细血管C4d染色的情况下诊断抗体介导的排斥反应（AMR）。我们的目标是量化与1）C4d阳性AMR患者（n = 156）和2）无AMR的匹配对照组相比，持续C4d阴性的AMR（n = 51）患者的同种异体移植丢失风险。回顾了从1 / 04–06 / 14开始的所有第一年的移植后活检，并将其与供体特异性抗体（DSA）的存在相关联。 C4d阴性的AMR患者与C4d阳性的AMR患者在任何基线特征（包括免疫危险因素（PRA，先前移植，HLA失配，供体类型，DSA类别和抗HLA / ABO不相容性））上均无差异。 C4d阳性的AMR患者出现临床表现的可能性显着更高（85.3％对54.9％； P <0.001），而这些患者在移植后的病情要早得多（中位14 [IQR 8–32]天vs. 46 [IQR] [20–191]； P <0.001），是普通患者的三倍（7.8％比2.5％）。 C4d阴性的AMR患者定义AMR后一年和两年活检的存活率为93.4％和90.2％，而C4d阳性的AMR患者为86.8％和82.6％（P = 0.4）。与无AMR的对照组相比，C4d阴性的AMR与移植物丢失风险增加了2.56倍（95％CI：1.08–6.05； P = 0.033）。未鉴定出可将C4d阴性与C4d阳性AMR可靠地区分开的临床特征。然而，两种表型都与移植物损失增加有关，因此需要考虑进行干预。

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