Abstract: Objective：To investigate the relationships of C4d, HLA antibody, and MⅠCA antibody with renal pathology. Methods：Totally 52 patients with complete pathological data were included and followed up for one year. The C4d was stained with indirect immunofluorescence, the levels of HLA antibody and MⅠCA antibody in peripheral blood were detected by Luminex method. The relationships of C4d with antibodies in peripheral blood and pathology of renal graft were analyzed, and their influences on renal function were exposed. Results：The positive rate of HLA antibody was 88.9% in cases with positive C4d and 40% in the cases with negative C4d. The positive rate of HLA antibody was higher in patients with positive C4d than that in patients with negative C4d(P=0.003). The proportion of glomerulitis was higher in cases with positive C4d (P=0.023), and vasculitis and arterial intimal thickening of transplanted renal were more common in cases with positive HLA antibody than those with negative HLA antibody (P<0.05), while no correlations between histological features and MⅠCA antibody were found. There was no difference in glomerular filtration rate (GFR) between cases with positive and negative C4d, but in patients of positive C4d with positive HLA antibody or MⅠCA antibody, the GFR decreased more remarkably compared with those of single positive C4d (P<0.05). Conclusions：For patients of acute rejection, positive C4d combined with positive antibodies of HLA and MⅠCA in peripheral blood has better predictive value for graft survival compared with single positive C4d.