Evaluation of Renal Allograft Biopsies for Graft Dysfunction and Relevance of C4d Staining in Antibody Mediated Rejection
| Autor: | Himanshu V. Patel, Aruna V. Vanikar, Kyasakkala Sannaboraiah Vinay, Kamal Vinod Kanodia, Rashmi Dalsukhbhai Patel, Clement Wilfred Devadass, Lovelesh Kumar Nigam |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Pathology
medicine.medical_specialty Clinical Biochemistry lcsh:Medicine 030209 endocrinology & metabolism Pathogenesis 03 medical and health sciences 0302 clinical medicine renal biopsy Biopsy Pathology Section medicine 030212 general & internal medicine Prospective cohort study medicine.diagnostic_test business.industry lcsh:R General Medicine Gold standard (test) renal transplantation cni toxicity Transplantation peritubular capillary c4d deposition Toxicity Immunohistochemistry Renal biopsy business |
| Zdroj: | Journal of Clinical and Diagnostic Research, Vol 10, Iss 3, Pp EC11-EC15 (2016) |
| Popis: | 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 nonrejection 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. |
| Databáze: | OpenAIRE |
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