Clinical Implication Of Complement Split Product C4d And TCM Syndrome Differentiation-type In Patients With Chronic Allograft Nephropathy

[Objective](1) To explore the significance of peritubular capillary C4d deposition in histomorphologic features,renal function and prognosis of the patients with Chronic allograft nephropathy(CAN);(2) Preliminary Reveal the distribution of the syndrome of the patients with Chronic allograft nephropathy(CAN).[Methods](1) 77 allograft biopsies obtained from 77 kidney transplants were examined by immunohistochemistry on routine paraffin sections using anti-C4d polyclonal antibody.We analyzed the relationship of C4d and renal function,histomorphologic features,and prognoses of allografts and so on;(2) Patients were enrolled with CAN conforming to the inclusive and exclusive criteria,77 patients were enrolled with CAN study the distribution of the TCM Syndrome Differentiation-type(TCM-SDT).[Results](1) The frequency of C4d peritubular capillary deposition among patients with chronic allograft nephropathy was 45.5%.There were 7 allograft biopsies with Banff typeⅠ,35 with Banff typeⅡand 35 with Banff typeⅢ.35 biopsies were positive in C4d deposition.Evaluating peritubular C4d deposition,we found no significant differences between the groups.p=0.342.(2) Our stud showed the histomorphologic features were more advanced in the C4d(+)patients with a statistical difference for tubular atrophy and glomerular basement membrane stratified.The other do not reached statistical significance.(3) The C4d(+) group had proportionately more patients with high pane-reactive antibody levels and more retransplanted patients.No correlation was observed between C4d expression and patient age,gender,immunosuppression method,delayed graft function and timing of acute rejection episodes and so on.In C4d(+) patients chronic allograft nephropathy was diagnosed(30.6±28.8) month after transplantation,it were present prior to C4d(-).(4) The statistical analysis showed no impact of C4d expression on mean serum creatinine levels at the time of biopsy and during 1-year observation.Nevertheless,According to Kaplan-Meier analysis,the 1-year graft survival rate was significantly worse in the C4d(+)group(62.9%) than in the C4d(-) group(83.3%;log-rank P=0.038).(5) The distribution of deficiency syndrome as follows:spleen-kidney Qi deficiency(53.2%),hepatic and renal Yin deficiency (28.6%),spleen-kidney Yang Deficiency(18.2%).The distribution of sthenia syndrome as follows:syndrome of blood stasis(58.4%),damp-heat syndrome(20.8%),pathogenic damp(11.7%).[Conclusion]1.C4d peritubular capillary deposition is an reliable indicator of immunological activity of chronic allograft nephropathy.2.CAN with C4d deposition are associated with tubular atrophy and glomerular basement membrane stratified,but do not have specific.3.The C4d(+) group had proportionately more patients with high pane-reactive antibody levels and more retransplanted patients.After transplantation CAN is diagnosed more frequently with a greater risk of C4d detection.The possible influence of mainly immunological risk factors early after transplantation leads to manifestation of CAN in a shorter period.4.The study showed no impact of C4d expression on mean serum creatinine levels at the time of biopsy and during 1-year observation.More patients with peritubular C4d deposition lost their grafts during the study period.5.Deficiency syndrome-type with CAN usually are spleen-kidney Qi deficiency and hepatic and renal Yin deficiency;Sthenia syndrome with CAN usually are syndrome of blood stasis and damp-heat syndrome...