Detectable circulating antiendothelial cell antibodies in renal allograft recipients with C4d-positive acute rejection: a report of three cases

Transplantation. 2005 Jun 27;79(12):1759-62. doi: 10.1097/


It is suggested that non-HLA endothelial antigens may also cause C4d-positive acute rejection, but this is very rare. We report on three renal allograft recipients who developed C4d-positive acute rejection with detectable circulating antiendothelial cell antibodies (AECAs). All patients had severe dialysis-dependent graft dysfunction. Histologic manifestations include neutrophils infiltration on peritubular capillaries and glomeruli. Endoarteritis can be seen in all the patients. Two patients lost grafts after the rescue therapy including immunoadsorption, mycophenolate mofetil with or without tacrolimus. The titer variation of AECAs might be associated with the graft outcome. In patients those who lost grafts, AECAs titer increased from 1:10 to 1:80 in one patient, and was kept positive during the treatment in the other patient. In the recovered patient, however, the titer became negative from 1:40. From our report, it appears that persisting circulating AECAs during the rescue treatment of C4d-positive acute rejection may be associated with a poor outcome.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Capillaries / immunology
  • Capillaries / pathology
  • Complement C4b / immunology*
  • Endothelium, Vascular / immunology*
  • Female
  • Graft Rejection / immunology*
  • Graft Rejection / pathology
  • Humans
  • Isoantibodies / analysis*
  • Isoantibodies / blood
  • Kidney Glomerulus / immunology
  • Kidney Glomerulus / pathology
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / pathology*
  • Middle Aged
  • Peptide Fragments / immunology*
  • Transplantation, Homologous / immunology


  • Isoantibodies
  • Peptide Fragments
  • Complement C4b
  • complement C4d