Kidney transplants, antibodies and rejection: is C4d a magic marker?

Nephrol Dial Transplant. 2003 Nov;18(11):2232-9. doi: 10.1093/ndt/gfg304.


The immunohistochemical detection of the complement degradation product C4d in renal allograft biopsies has gained considerable clinical interest in recent years. The accumulation of C4d along peritubular capillaries is generally regarded as a marker for an antibody-mediated allo-response and is associated with poor graft survival. The aim of this review is to discuss histological findings associated with the deposition of C4d. Emphasis is placed on diagnostic and therapeutic implications. Unanswered questions regarding C4d and graft injury are highlighted.

Publication types

  • Review

MeSH terms

  • Biomarkers
  • Complement C4 / metabolism*
  • Complement C4b*
  • Graft Rejection / metabolism*
  • Graft Rejection / pathology
  • Graft Rejection / therapy
  • Humans
  • Isoantibodies / metabolism*
  • Kidney / metabolism*
  • Kidney / pathology
  • Kidney Transplantation*
  • Peptide Fragments / metabolism*


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