{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T12:29:07Z","timestamp":1790944147758,"version":"4.1.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,2]]},"abstract":"Summary<\/jats:title>\n \n Background and objectives<\/jats:title>\n This study characterizes the pathologic and clinical relationships of thrombotic microangiopathy (TMA) to antibody-mediated rejection (AMR) in renal allograft biopsies.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n Consecutive renal allograft biopsies, routinely stained for C4d over a period of 51 months (\n n<\/jats:italic>\n = 1101), were reviewed. For comparative analysis of histology and clinical features, additional patients with TMA and peritubular capillary (PTC) C4d (\n n<\/jats:italic>\n = 5) were combined with those identified in the 51-month period of review (\n n<\/jats:italic>\n = 6).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n One hundred eighty-two of 1073 adequate biopsies from 563 allografts had PTC C4d in the study period. Six of 37 biopsies with TMA had PTC C4d (five at \u226490 days and one at 213 days). Early (\u226490 days) C4d+ biopsies (\n n<\/jats:italic>\n = 5) had more frequent TMA (11.9% C4d+\n versus<\/jats:italic>\n 3.4% C4d\u2212; odds ratio, 3.84;\n P<\/jats:italic>\n = 0.03). Graft loss was significantly greater in an early C4d+TMA+ group (\n n<\/jats:italic>\n = 5 study + 2 archival patients) than in C4d+ controls without TMA (\n n<\/jats:italic>\n = 21) (57%\n versus<\/jats:italic>\n 9.5%;\n P<\/jats:italic>\n = 0.02). Early TMA+C4d+ biopsies had more severe glomerulopathy and less severe arteriolopathy than TMA+C4d\u2212 and had more frequent neutrophilic capillaritis than TMA\u2212C4d+ biopsies.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n TMA was infrequent in this series of unselected, consecutive, renal allograft biopsies (3.4%). PTC C4d may be a significant risk factor for early TMA, and TMA is associated with glomerular thrombi and neutrophilic capillaritis. TMA in allografts with suspected AMR may portend a higher risk of graft loss.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.05870710","type":"journal-article","created":{"date-parts":[[2010,10,22]],"date-time":"2010-10-22T00:54:47Z","timestamp":1287708887000},"page":"395-403","source":"Crossref","is-referenced-by-count":44,"title":["Thrombotic Microangiopathy and Peritubular Capillary C4d Expression in Renal Allograft Biopsies"],"prefix":"10.2215","volume":"6","author":[{"given":"Shane M.","family":"Meehan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah N.","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Curley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Marino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep V.","family":"Kadambi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-23-20230811","first-page":"28","article-title":"Thrombotic microangiopathy in renal transplantation","volume":"7","author":"Chiurchiu","year":"2002","journal-title":"Ann Transplant"},{"key":"R2-23-20230811","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1681\/ASN.V10102208","article-title":"Complement activation in acute humoral renal allograft rejection: Diagnostic significance of C4d deposits in peritubular capillaries","volume":"10","author":"Collins","year":"1999","journal-title":"J Am Soc Nephrol"},{"key":"R3-23-20230811","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1681\/ASN.V131242","article-title":"Detection of the complement degradation product C4d in renal allografts: Diagnostic and therapeutic implications","volume":"13","author":"Nickeleit","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"R4-23-20230811","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1681\/ASN.V1341091","article-title":"Capillary C4d deposition in kidney allografts: A specific marker of alloantibody-dependent graft injury","volume":"13","author":"Bohmig","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"R5-23-20230811","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/j.1600-6143.2008.02159.x","article-title":"Banff 07 classification of renal allograft pathology: Updates and future directions","volume":"8","author":"Solez","year":"2008","journal-title":"Am J Transplantation"},{"key":"R6-23-20230811","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1681\/ASN.V133779","article-title":"Acute humoral rejection in kidney transplantation: II. 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