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Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 678180, 8 pages
http://dx.doi.org/10.1155/2013/678180
Review Article

The Importance of C4d in Biopsies of Kidney Transplant Recipients

1Discipline of General Pathology, Nephropathology Service, Federal University of Triângulo Mineiro, Frei Paulino, 30, 38025-180 Uberaba, Brazil
2Discipline of Immunology, Federal University of Triângulo Mineiro, Frei Paulino, 30, 38025-180 Uberaba, Brazil
3Discipline of Cell Biology, Federal University of Triângulo Mineiro, Frei Paulino, 30, 38025-180 Uberaba, Brazil

Received 31 January 2013; Revised 15 May 2013; Accepted 23 June 2013

Academic Editor: Aron Chakera

Copyright © 2013 Rosana Rosa Miranda Corrêa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Antibody-mediated rejection (AMR) is highly detrimental to the prolonged survival of transplanted kidneys. C4d has been regarded as a footprint of AMR tissue damage, and the introduction of C4d staining in daily clinical practice aroused an ever-increasing interest in the role of antibody-mediated mechanisms in allograft rejection. Despite the general acceptance of the usefulness of C4d in the identification of acute AMR, the data for C4d staining in chronic AMR is variable. The presence of C4d in the majority of the biopsies with features of chronic antibody-mediated rejection is reported, but this rejection without C4d staining is observed as well, suggesting that C4d is specific but not sensitive. Further studies on AMR with positive C4d staining in biopsy specimens are really important, as well as the study of novel routine markers that may participate in the pathogenesis of this process.