Evidence map›Paper›PMID 42435125›Full record

ArticleClinical and experimental nephrology2026

Early glomerular capillary C4d is associated with poor graft function in kidney transplant recipients with preformed donor-specific antibodies.

Yuki Shimamoto, Manabu Okada, Takahisa Hiramitsu, Asami Takeda, Ayano Ienaga, Tomoki Himeno, Yuki Hasegawa, Kenta Futamura, Shunji Narumi, Yoshihiko Watarai and 1 more

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Article in Clinical and experimental nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Yuki ShimamotoDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan. yukishimamot@nagoya2.jrc.or.jp.ORCID http://orcid.org/0000-0002-0606-3569
Manabu OkadaDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Takahisa HiramitsuDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Asami TakedaDepartment of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan.
Ayano IenagaDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Tomoki HimenoDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Yuki HasegawaDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Kenta FutamuraDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Shunji NarumiDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Yoshihiko WataraiDepartment of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Takaaki KobayashiDepartment of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe role of positive glomerular capillary C4d (C4dglom) in chronic antibody-mediated rejection (ABMR) has been examined. However, the role of C4dglom in the development of transplant glomerulopathy (TG) and graft outcomes in the early phase after kidney transplantation (KT) among patients with preformed donor-specific antibodies (preDSAs) remains undetermined.

methodsIn this single-center, retrospective cohort study, we included 110 kidney transplant recipients (KTRs) with preDSAs (2008-2024, median follow-up: 7.8 years). Overall, 325 index and indication biopsies were performed within 1 year post-KT. All biopsy specimens were stained with immunofluorescent C4d. C4dglom was defined as global, moderate to severe, pseudolinear glomerular capillary wall staining, and peritubular capillary C4d (C4dptc), as described in Banff 2019. Patients were divided into two groups, with or without C4dglom, within 1 year post-KT. The association between C4dglom and TG was evaluated. Further, among KTRs with ABMR or TG, the incidence of a 30% decline in estimated glomerular filtration rate (eGFR) within 1 year post-KT and eGFR at 1 year post-KT were compared according to the presence or absence of C4dglom or C4dptc.

resultsTwenty-two cases of C4dglom and 26 cases of TG were identified within 1 year post-KT. C4dglom was associated with TG development. In the TG group, C4dglom positivity was associated with a significantly lower 30% decline in eGFR-free survival than C4dglom negativity (45.7% vs 92.9%, p = 0.036), whereas C4dptc positivity was not (71.4% vs 70.3%, p = 0.979).

conclusionC4dglom was associated with subsequent TG and even poor graft function.

Indexed as

Complement C4bGraft RejectionIsoantibodiesKidney GlomerulusKidney TransplantationPeptide FragmentsAdultCapillariesFemaleGlomerular Filtration RateGraft SurvivalHumansMaleMiddle AgedRetrospective StudiesComplement C4bcomplement C4dIsoantibodiesPeptide FragmentsAntibody-mediated rejectionGlomerular capillary C4dGraft survivalKidney transplantationRenal pathology

Identifiers

PMID42435125

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.