eISSN: 2345-2781  
Submitted: 03 Jun 2017

Accepted: 10 Jul 2018
First published online: 03 Jan 2018
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J Renal Inj Prev. 2018;7(3):189-196.
doi: 10.15171/jrip.2018.45

Original Article

Frequency of acute antibody mediated rejection in renal allograft biopsies as detected by morphological findings and C4d immunostaining

Hina Tariq * , Humaira Nasir

1 Histopathology Department, Shifa International Hospital, Islamabad, Pakistan

Abstract

Introduction: Acute antibody-mediated rejection (AMR) detection using C4d immunofluorescence in combination with histopathological examination in renal allograft biopsy is a gold standard for AMR. This study will be the first one in this context in Pakistan and will generate local data.

Objectives: To determine the frequency of AMR in renal allograft biopsies as detected by morphological findings and C4d immunostaining.

Patients and Methods: We performed a prospective cross-sectional study at histopathology department, Shifa international hospital, Islamabad. Allograft biopsies which were performed for diagnosis of graft dysfunction were included. Interpretation was performed, according to Banff 2013. All statistical analysis of the data was performed using statistical software SPSS 20.

Results: A total of 60 biopsies, including 59 (98.3%) males and 1 (1.7%) female were evaluated. Age range was 15-65 years (mean 34.6 ± 11.8). Out of 60 biopsies, in the early post-transplant period, 14 (23.3%) out of 60 cases were diagnosed as AMR on morphology. One (1.6%) case had strong C4d positive in absence of morphological features. Out of these cases, 8 (57.1%) showed C4d positivity, 2 (14.3%) showed focal C4d positivity while 4 (28.6%) were C4d negative. In the late post-transplant period, chronic allograft nephropathy (CAN) cases were 19 (31.7%). Out of these cases, 13 (68.4%) showed morphological features of AMR. C4d was positive 11 (57.9%) and C4d was negative in 2 cases (10.5%).

Conclusion: C4d positivity favors AMR; however, it can be seen in absence of morphological features.

Implication for health policy/practice/research/medical education:

Acute antibody-mediated rejection (AMR) has emerged as an important reason of allograft dysfunction. Histopathologic assessment of post-transplant renal biopsies was routinely performed in many canters for AMR. C4d has emerged as an easy and inexpensive means of detection of AMR. With its help in combination with histopathological findings, AMR can be timely diagnosed. These patients could be benefited from anti-humoral therapy and prevented from more intense rejection in future.

Please cite this paper as: Tariq H, Nasir H. Frequency of acute antibody mediated rejection in renal allograft biopsies as detected by morphological findings and C4d immunostaining. J Renal Inj Prev. 2018;7(3):189-196. doi: 10.15171/jrip.2018.45.

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