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.