Volume 83, Issue 6, Pages (June 2013)

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Volume 83, Issue 6, Pages 1185-1192 (June 2013) Increased C4d in post-reperfusion biopsies and increased donor specific antibodies at one-week post transplant are risk factors for acute rejection in mild to moderately sensitized kidney transplant recipients Arjang Djamali, Brenda L. Muth, Thomas M. Ellis, Maha Mohamed, Luis A. Fernandez, Karen M. Miller, Janet M. Bellingham, Jon S. Odorico, Joshua D. Mezrich, John D. Pirsch, Tony M. D'Alessandro, Vijay Vidyasagar, R. Michael Hofmann, Jose R. Torrealba, Dixon B. Kaufman, David P. Foley Kidney International Volume 83, Issue 6, Pages 1185-1192 (June 2013) DOI: 10.1038/ki.2013.44 Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 1 Changes in donor-specific antibody (DSA) after transplantation. (a) The bar graph displays mean DSA levels (mean fluorescence intensity (MFI)max) early post transplant in all desensitization protocols. (b) The graph shows mean DSA levels in all patients throughout the first posttransplant year. DSA increased with time despite immunosuppression and desensitization. MFIsum class II was the primary cause of the rise in DSA. Kidney International 2013 83, 1185-1192DOI: (10.1038/ki.2013.44) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 2 Post-reperfusion biopsy and C4d staining. (a) Percentage patients in each protocol that underwent a post-reperfusion biopsy (blue bar) and percentage patients in each protocol that had positive C4d staining in the reperfusion biopsy (red bar). Actual numbers are displayed within the bars. (b) C4d staining by immunoperoxidase in a post-reperfusion biopsy (a) and in a pre-implantation control biopsy (b). Only some of the post-reperfusion biopsies were positive for C4d. Kidney International 2013 83, 1185-1192DOI: (10.1038/ki.2013.44) Copyright © 2013 International Society of Nephrology Terms and Conditions

Figure 3 Kaplan–Meier survival curve for rejection-free probability in patients with or without post-reperfusion C4d staining. C4d (+) patients were at significantly greater risk for antibody-mediated or mixed rejection. CI, confidence interval; HR, hazard ratio. Kidney International 2013 83, 1185-1192DOI: (10.1038/ki.2013.44) Copyright © 2013 International Society of Nephrology Terms and Conditions