C4d complement split product expression in chronic rejection of renal allograft

Transplant Proc. 2003 Sep;35(6):2190-2. doi: 10.1016/s0041-1345(03)00799-1.


Chronic allograft rejection remains the major cause of late renal graft loss. Its pathogenesis is complex, depending on both immunological and nonimmunological factors. An important role in development of chronic rejection is ascribed to an ongoing immunological reaction mainly of the humoral type. C4d complement split product, as a stable fragment of complement degradation activated by antigen-antibody complexes, is considered to be an indicator of humoral activity in allografts. The aim of the present study was to establish a correlation between C4d expression and morphological findings specific for chronic rejection among biopsy specimens from patients with deteriorating graft function versus protocol biopsy specimens versus biopsy specimens of native kidneys with glomerular diseases. C4d deposits in peritubular capillaries and glomeruli were observed in 83% of patients with morphological changes of chronic rejection. No C4d expression was found in the protocol biopsy group. C4d deposits in glomeruli localizations were found in kidneys from patients with glomerulopathies; the pattern of distribution was similar to that for antibodies characteristic for glomerulonephritis. There was a positive correlation between C4d expression and morphological features of chronic rejection. In our opinion, only peritubular capillary localization is specific for a rejection process; glomerular localization is nonspecific and probably secondary to antigen-antibody complex deposition in course of some types of glomerulopathies.

MeSH terms

  • Biopsy
  • Chronic Disease
  • Complement C4 / genetics*
  • Complement C4b*
  • Graft Rejection / blood*
  • Humans
  • Kidney Glomerulus / pathology
  • Kidney Transplantation / pathology
  • Kidney Transplantation / physiology*
  • Peptide Fragments / genetics*


  • Complement C4
  • Peptide Fragments
  • Complement C4b
  • complement C4d