Evaluation of Renal Allograft Biopsies for Graft Dysfunction and Relevance of C4d Staining in Antibody Mediated Rejection

Devadass, Clement Wilfred; Vanikar, A V; Nigam, Lovelesh K.; Kanodia, Kamal V; Patel, Rashmi D; Vinay, Kyasakkala Sannaboraiah; Patel, Himanshu V.

doi:10.7860/jcdr/2016/16339.7433

Cited by 5 publications

(7 citation statements)

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“…The earlier study by Devadas also showed similar results and 60% of graft dysfunction was due to acute rejection and 40% of graft dysfunction was due to CNI toxicity, recurrence of primary glomerular disease, acute tubular necrosis and infection. 4 Histopathological pattern of acute rejection in our study showed that antibody-mediated rejection occurred in 50% of recipients, T cell-mediated rejection in 30% of patients and combined antibody mediated and T cell-mediated rejection in 20% of recipients. The earlier studies also showed similar results and antibody-mediated rejection was 87% and T cell-mediated rejection was 13%.…”

Section: Discussionsupporting

confidence: 47%

A Four-Year Retrospective Observational Study of the Outcome of Deceased Donor Kidney Transplantation- A Single Centre Study

Puthiyotti¹,

Krishnan²,

Melemadathil³

2016

jebmh

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BACKGROUNDThe aim of the study is to study the outcome of deceased donor kidney transplantation at the end of one year, the effect of cold ischaemia on the outcome of graft survival and the role of various induction agents in the prevention of acute rejection. MATERIALS AND METHODSA retrospective observational study of 30 deceased donor kidney transplant recipients was conducted. All patients received triple drug immunosuppressive treatment, i.e. tacrolimus, steroids and mycophenolate. Induction with either ATG or basiliximab was given to all recipients. The graft function was monitored serially with serum creatinine and routine urine examination. Graft biopsy was done in the event of graft dysfunction. Development of infection was confirmed by serological examination and cultures of various body fluids. RESULTSOne year graft survival was 80% and patient survival was 83%. Delayed graft function was seen in 30% and acute rejection in 33%. Cold ischaemia was more than 6 hours in 23%. Induction was given to all patients and graft function was similar in both groups. 40% patients developed infection during the first year. CONCLUSIONOne year graft survival is 80% and patient survival is 83%. 40% patients developed infection.

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Section: Discussionsupporting

confidence: 47%

A Four-Year Retrospective Observational Study of the Outcome of Deceased Donor Kidney Transplantation- A Single Centre Study

Puthiyotti¹,

Krishnan²,

Melemadathil³

2016

jebmh

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“…Despite modern diagnostic procedures implemented in everyday clinical practice, the kidney allograft biopsy remains a gold standard to determine the cause of graft dysfunction. Biopsy findings change the clinical diagnosis in an average of 36% of patients (range 24-76) and immunosuppressive therapy in 59% [ 15 ] [ 16 ]. But, the allograft biopsy does not contribute only to clinical diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The Spectrum of Histopathological Changes in the Renal Allograft - a 12 Months Protocol Biopsy Study

Severova-Andreevska¹,

Grcevska²,

Petrushevska³

et al. 2018

Open Access Maced J Med Sci

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INTRODUCTION:Renal transplantation became a routine and successful medical treatment for Chronic Kidney Disease in the last 30 years all over the world. Introduction of Luminex based Single Antigen Beads (SAB) and recent BANFF consensus of histopathological phenotypes of different forms of rejection enables more precise diagnosis and changes the therapeutic approach. The graft biopsies, protocol or cause, indicated, remain a golden diagnostic tool for clinical follow up of kidney transplant recipients (KTR).AIM:The study aimed to analyse the histopathological changes in renal grafts 12 months after the surgery in KTR with satisfactory kidney function.MATERIAL AND METHODS:A 12-month protocol biopsy study was performed in a cohort of 50 Kidney transplant recipients (42 from living and 8 from deceased donors). Usual work-up for suitable donors and recipients, standard surgical procedure, basic principles of peri and postoperative care and follow up were done in all KTR. Sequential quadruple immunosuppression including induction with Anti-thymocyte globulin (ATG) or Interleukin-2R antagonist (IL-2R), and triple drug maintenance therapy with Calcineurin Inhibitors (CNI), Mycophenolate Mofetil (MMF) and Steroids were prescribed to all pts. Different forms of Glomerulonephritis (16), Hypertension (10), End Stage Renal Disease (13), Hereditary Nephropathies (6), Diabetes (3) and Vesicoureteral Reflux (2) were the underlying diseases. All biopsies were performed under ultrasound guidance. The 16 gauge needles with automated “gun” were used to take 2 cores of tissue. The samples were stained with HE, PAS, Trichrome Masson and Silver and reviewed by the same pathologist. A revised and uploaded BANFF 2013 classification in 6 categories (Cat) was used.RESULTS:Out of 48 biopsies, 15 (31%) were considered as normal, 4 (8%), Borderline (BL-Cat 3), 5 (10%) as Interstitial Fibrosis/Tubular Atrophy (IF/TA-Cat 5), 5 (10%) were classified as non-immunological (Cat 6), 2 as a pure antibody-mediated rejection (ABMR-Cat 2) and T-cell Mediated Rejection (TCMR-Cat 4). The remaining 17 samples were classified as a “mixed” rejection: 7 (41%) ABMR + IF/TA, 5 (29%) ABMR + BL + IF/TA, 2 (11%) BL + IF/TA, 1 (5%) ABMR + BL, 1 (5%) ABMR + TCMR and 1 (5%) TCMR + IF/TA. The mean serum creatinine at the time of the biopsy was 126.7 ± 23.4 µmol/L, while GFR-MDRD 63.4 ± 20.7 ml/min, which means that the majority of the findings were subclinical. Among the non-immunological histological findings (Cat 6), 3 cases belonged to CNI toxicity, 1 to BK nephropathy and 1 to recurrence of the primary disease.CONCLUSION:Our 12-month protocol biopsy study revealed the presence of different forms of mixed subclinical rejection. Use of recent BANFF classification and scoring system enables more precise diagnosis and subsequently different approach to the further treatment of the KTR. More correlative long-term studies including Anti HLA antibodies and Endothelial Cell Activation- Associated Transcripts (ENDAT) are needed.

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“…Philip et al reported one case of recurrent GN, which was recurrent IgAN (12). Aryal et al, Devadass et al and Puntamekar et al did not observe any recurrent GN (6,14,20). Different studies give disparate clinical presentations of recurrent GN ranging from asymptomatic urinary abnormalities to rapidly progressive GN (21).…”

Section: Discussionmentioning

confidence: 94%

“…CNI Toxicity formed the second largest group, in the present study (19.7%) which is similar to studies by Philip et al (16%) and Aryal et al (28.5%) (6,12). However, in studies by Severova et al and Devadass et al (41.3%), it was the predominant cause of NRI (13,14). The pathogenesis of CNI toxicity is multi-factorial and involves enhanced rennin secretion, relative nitric oxide deficiency, superoxide and peroxynitrite induced injury and loss of vascular endothelial growth factor support to the microvasculature (5).…”

Section: Discussionmentioning

confidence: 99%

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Histopathologic patterns of nonrejection injury in renal allograft biopsies and their clinical characteristics; a single centre south Indian study

et al. 2020

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Introduction: Graft dysfunction (GD) is the major complication of renal transplantation, and may result in graft loss. The major causes of GD are immunological rejection and non-rejection injury (NRI), which have different prognostic and therapeutic connotations. Meticulous renal allograft biopsy (RAB) evaluation and its correlation with clinico-laboratory features are crucial for timely identification of the varied NRI. Objectives: To evaluate the clinico-laboratory characteristics and histopathologic features of NRI in "clinically indicated" RABs in our institution. Patients and Methods: This was a prospective study conducted over a period of five years on renal transplant recipients who underwent "clinically indicated" RAB for GD. Results: A total of 192 biopsies were evaluated which showed NRI, rejection and NRI with concurrent rejection in 57.3%, 26.6% and 3.6% cases respectively. The NRI category, with or without concurrent rejection, comprised of acute tubular injury (ATI) (44%), calcineurin inhibitor induced (CNI) toxicity (19.7%), infections (12.8%), recurrent glomerulonephritis (GN) (7.7%), de novo GN (1.7%), chronic interstitial nephritis (9.4%), thrombotic microangiopathy (2.6%) and renal vein thrombosis (1.7%). Mean patient age was 34.9 years with male: female ratio of 8:1. Conclusion: Timely differentiation between rejection and NRI is indispensable for improved allograft survival. Acute tubular injury is the major NRI causing delayed graft function (DGF), and is commonly associated with deceased donor renal transplantation. The blood concentration of CNI does not correlate with the extent of renal damage. Acute tubular injury and CNI toxicity are the major NRI, in the first six months post-transplantation and after six months post-transplantation, respectively.

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Evaluation of Renal Allograft Biopsies for Graft Dysfunction and Relevance of C4d Staining in Antibody Mediated Rejection

Cited by 5 publications

References 15 publications

A Four-Year Retrospective Observational Study of the Outcome of Deceased Donor Kidney Transplantation- A Single Centre Study

A Four-Year Retrospective Observational Study of the Outcome of Deceased Donor Kidney Transplantation- A Single Centre Study

The Spectrum of Histopathological Changes in the Renal Allograft - a 12 Months Protocol Biopsy Study

Histopathologic patterns of nonrejection injury in renal allograft biopsies and their clinical characteristics; a single centre south Indian study

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