Clement Wilfred Devadass1, Aruna Vishwanth Vanikar2, Lovelesh Kumar Nigam3, Kamal Vinod Kanodia4, Rashmi Dalsukhbhai Patel4, Kyasakkala Sannaboraiah Vinay5, Himanshu V Patel6. 1. Associate Professor, Department of Pathology, M.S Ramaiah Medical College and Hospitals , MSRIT Post, MSRNagar, Bangalore, India . 2. ICMR Mentor and Guide, Professor & Head, Department of Pathology, Lab Medicine, Tranfusion Services & Immunohematology, Institute of Kidney Diseases and Research Centre & DR. H.L Trivedi Institute of Transplantation Sciences , B.J. Medical College & Civil Hospital Campus, Asarwa, Gujarat, India . 3. Assistant Professor (Junior Nephropathologist), Department of Pathology, Lab Medicine, Tranfusion Services & Immunohematology, Institute of Kidney Diseases and Research Centre & DR. H.L Trivedi Institute of Transplantation Sciences , B.J. Medical College & Civil Hospital Campus, Asarwa, Gujarat, India . 4. Professor (Senior Nephropathologist), Department of Pathology, Lab Medicine, Tranfusion Services & Immunohematology, Institute of Kidney Diseases and Research Centre & DR. H.L Trivedi Institute of Transplantation Sciences , B.J. Medical College & Civil Hospital Campus, Asarwa, Gujarat, India . 5. PDCC Fellow, Department of Pathology, Lab Medicine, Tranfusion Services & Immunohematology, Institute of Kidney Diseases and Research Centre & DR. H.L Trivedi Institute of Transplantation Sciences , B.J. Medical College & Civil Hospital Campus, Asarwa, Gujarat, India . 6. Professor, Department of Nephrology, Institute of Kidney Diseases and Research Centre & DR. H.L Trivedi Institute of Transplantation Sciences , B.J. Medical College & Civil Hospital Campus, Asarwa, Gujarat, India .
Abstract
INTRODUCTION: Biopsy remains gold standard for diagnosis of Graft Dysfunction (GD). It guides clinical management, provides valuable insights into pathogenesis of early and late allograft injury and is indispensable for distinguishing rejection from non- rejection causes of GD. AIM: The primary aim of the study was to evaluate the diverse histomorphological lesions in renal allograft biopsy (RAB). Further, we determined the frequency of peritubular capillary (PTC) C4d positivity and its correlation with microvascular inflammation in Antibody Mediated Rejection (AMR). MATERIALS AND METHODS: This was a prospective study on RAB over a period of 2 months. Histopathological evaluation was undertaken as per revised Banff'13 schema. Immunohistochemistry was performed to detect PTC C4d deposition. RESULTS: Sixty five diagnostic biopsies were evaluated. Mean patient age was 34 years and males were predominant. The time interval between graft biopsy and transplantation ranged from 5 days to 8 years, with 52.3% biopsies belonging to period of ≤ 6 months post-transplant. Immune injuries were observed in 40 biopsies out of which AMR was observed in 35 biopsies. Calcineurin inhibitor toxicity (CNI Toxicity) was the second commonest cause observed in 12 biopsies and other lesions including de novo glomerulopathies were observed in the remaining biopsies. The sensitivity of C4d in detecting acute AMR was 55% and chronic AMR was 23.5. CONCLUSION: AMR and CNI Toxicity account for majority of graft dysfunction. C4d is not as sensitive a marker of AMR, as was initially thought. Higher proportion of moderate microvascular inflammation is found in diffuse C4d positive cases compared to focal C4d positive cases.
INTRODUCTION: Biopsy remains gold standard for diagnosis of Graft Dysfunction (GD). It guides clinical management, provides valuable insights into pathogenesis of early and late allograft injury and is indispensable for distinguishing rejection from non- rejection causes of GD. AIM: The primary aim of the study was to evaluate the diverse histomorphological lesions in renal allograft biopsy (RAB). Further, we determined the frequency of peritubular capillary (PTC) C4d positivity and its correlation with microvascular inflammation in Antibody Mediated Rejection (AMR). MATERIALS AND METHODS: This was a prospective study on RAB over a period of 2 months. Histopathological evaluation was undertaken as per revised Banff'13 schema. Immunohistochemistry was performed to detect PTC C4d deposition. RESULTS: Sixty five diagnostic biopsies were evaluated. Mean patient age was 34 years and males were predominant. The time interval between graft biopsy and transplantation ranged from 5 days to 8 years, with 52.3% biopsies belonging to period of ≤ 6 months post-transplant. Immune injuries were observed in 40 biopsies out of which AMR was observed in 35 biopsies. Calcineurin inhibitortoxicity (CNI Toxicity) was the second commonest cause observed in 12 biopsies and other lesions including de novo glomerulopathies were observed in the remaining biopsies. The sensitivity of C4d in detecting acute AMR was 55% and chronic AMR was 23.5. CONCLUSION: AMR and CNI Toxicity account for majority of graft dysfunction. C4d is not as sensitive a marker of AMR, as was initially thought. Higher proportion of moderate microvascular inflammation is found in diffuse C4d positive cases compared to focal C4d positive cases.
Authors: Anjali A Satoskar; Amy M Lehman; Gyongyi M Nadasdy; Daniel D Sedmak; Todd E Pesavento; Mitchell L Henry; Ronald P Pelletier; Ronald M Ferguson; Tibor Nadasdy Journal: Clin Transplant Date: 2008 Jan-Feb Impact factor: 2.863
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Authors: M Haas; B Sis; L C Racusen; K Solez; D Glotz; R B Colvin; M C R Castro; D S R David; E David-Neto; S M Bagnasco; L C Cendales; L D Cornell; A J Demetris; C B Drachenberg; C F Farver; A B Farris; I W Gibson; E Kraus; H Liapis; A Loupy; V Nickeleit; P Randhawa; E R Rodriguez; D Rush; R N Smith; C D Tan; W D Wallace; M Mengel Journal: Am J Transplant Date: 2014-02 Impact factor: 8.086
Authors: Rosana Rosa Miranda Corrêa; Juliana Reis Machado; Marcos Vinícius da Silva; Fernanda Rodrigues Helmo; Camila Souza Oliveira Guimarães; Laura Penna Rocha; Ana Carolina Guimarães Faleiros; Marlene Antônia dos Reis Journal: Clin Dev Immunol Date: 2013-07-09
Authors: Jieun Kim; Dong-Moung Kim; Yu Jin Park; Seung-Tae Lee; Hyon-Suk Kim; Myoung Soo Kim; Beom Seok Kim; Jong Rak Choi Journal: Ann Lab Med Date: 2021-09-01 Impact factor: 3.464