{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:43:51Z","timestamp":1753879431055,"version":"3.41.2"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T00:00:00Z","timestamp":1503360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pediatric renal transplant recipient survival continues to improve, but <jats:styled-content style=\"fixed-case\">ABMR<\/jats:styled-content> remains a significant contributor to graft loss. <jats:styled-content style=\"fixed-case\">ABMR<\/jats:styled-content> prognostic factors to guide treatment are lacking. C4d staining on biopsies, diagnostic of <jats:styled-content style=\"fixed-case\">ABMR<\/jats:styled-content>, is associated with graft failure. Persistent C4d+ on follow\u2010up biopsies has unknown significance, but could be associated with worse outcomes. We evaluated a retrospective cohort of 17 pediatric renal transplant patients diagnosed with <jats:styled-content style=\"fixed-case\">ABMR<\/jats:styled-content>. Primary outcome at 12\u00a0months was a composite of \u226550% reduction in eGFR, transplant glomerulopathy, or graft failure. Secondary outcome was the UPCR at 12\u00a0months. We used logistic and linear regression modeling to determine whether persistent C4d+ on follow\u2010up biopsy was associated with the outcomes. Forty\u2010one percent reached the primary outcome at 12\u00a0months. Persistent C4d+ on follow\u2010up biopsy occurred in 41% and was not significantly associated with the primary outcome, but was significantly associated with the secondary outcome (estimate 0.22, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.19\u20100.25, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001), after controlling for confounding factors. Persistent C4d+ on follow\u2010up biopsies was associated with a higher UPCR at 12\u00a0months. Patients who remain C4d+ on follow\u2010up biopsy may benefit from more aggressive or prolonged <jats:styled-content style=\"fixed-case\">ABMR<\/jats:styled-content> treatment.<\/jats:p>","DOI":"10.1111\/petr.13035","type":"journal-article","created":{"date-parts":[[2017,8,23]],"date-time":"2017-08-23T04:38:40Z","timestamp":1503463120000},"source":"Crossref","is-referenced-by-count":1,"title":["Persistent C4d and antibody\u2010mediated rejection in pediatric renal transplant patients"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3204-4142","authenticated-orcid":false,"given":"Andrew M.","family":"South","sequence":"first","affiliation":[{"name":"Section of Nephrology, Department of Pediatrics Wake Forest School of Medicine  Winston Salem NC USA"},{"name":"Cardiovascular Sciences Center Wake Forest School of Medicine  Winston Salem NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Maestretti","sequence":"additional","affiliation":[{"name":"Pediatric Renal Transplant Program Lucile Packard Children's Hospital at Stanford  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeraja","family":"Kambham","sequence":"additional","affiliation":[{"name":"Department of Pathology Stanford University School of Medicine  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul C.","family":"Grimm","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Pediatrics Stanford University School of Medicine  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abanti","family":"Chaudhuri","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Pediatrics Stanford University School of Medicine  Stanford CA 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