Diagnostic efficacy of C4d immunostaining in the detection of the humoral component of renal allograft rejection and therapeutic implications

Guduru, Sree Latha; Kuruvilla, Sarah; Abraham, Georgi; Mathew, Milly; Saravanan, S.

doi:10.4103/0377-4929.54990

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…Out of these, 81% were of presumptive antibody mediated rejection P-AbAR/ AMR (6). Analysis of C4d immunostaining shows agreement quite well with various histopathological findings for AMR (11). Comparing renal transplant recipients with and without AMR, patients exhibiting subclinical AMR (C4d positivity and capillaritis/glomerulitis) in their first biopsy were found to be at an increased risk of more intense chronic lesions in their follow-up biopsies (17).…”

Section: Introductionsupporting

confidence: 54%

“…Histopathologic assessment of post-transplant renal biopsies was routinely performed in many centers. Detection of C4d in renal allograft biopsy by IF in combination with routine histopathological examination is now the gold standard for AMR (6,11,12). Banff group of nephrologists and transplant pathologists is leading body for updating classification of renal allograft rejection.…”

Section: Introductionmentioning

confidence: 99%

“…These patients could be benefited from anti-humoral therapy and prevented from more intense rejection in the future (2,18). Despite the emergence of various molecular techniques, like panel reactive antibody (PRA) levels, flow cytometry cross-match and flow PRA bead assays, biopsy remains gold standard for detection of AMR (6,(11)(12)(13)19).…”

Section: Introductionmentioning

confidence: 99%

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

Tariq¹,

Nasir²

2018

J Renal Inj Prev

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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.

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Section: Introductionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Tariq¹,

Nasir²

2018

J Renal Inj Prev

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“…[8] In India, there are two published reports on C4d immunostaining. [45] The present study is our data of C4d immunostaining in non-protocol-indicated renal allograft biopsies. However, serological donor antibodies (DSA) were not available for any of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…The role of C4d immunostaining in renal allograft biopsies has been published from India earlier. [45] In this study we analyzed the pattern of C4d staining in all renal allograft biopsies done for graft dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Renal allograft pathology with C4d immunostaining in patients with graft dysfunction

Kulkarni¹,

Ms²,

Ak³

et al. 2011

Indian J Nephrol

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Renal allograft biopsy is the gold standard for diagnosis of rejection. Incorporation of C4d as a marker for humoral rejection is a major addition for Banff Schema, 2005. We evaluated the pattern of C4d staining in indicated renal allograft biopsies from January 2005 to December 2009. Of the 67 biopsies analyzed, 21 were C4d-positive. They were 11 cases of acute rejection, seven chronic rejection and one biopsy each of acute tubular necrosis, BK virus nephropathy and normal biopsy. Morphologic features like peritubular capillary dilatation, tubulitis and interstitial inflammation were seen more frequently in C4d-positive biopsies and this was statistically significant. C4d positivity was noted in 50% of the chronic rejection cases indicating a humoral component in the pathogenesis of chronic rejection. There was no significant difference in the serum creatinine levels of C4d-positive and -negative patients, either at the time of biopsy or during the follow-up. This study supports the role of C4d immunostaining in confirming histologically diagnosed acute and chronic humoral rejections and in detecting histologically unsuspected cases.

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Evolution of deceased-donor transplantation in India with decline of commercial transplantation: a lesson for developing countries

Abraham

Reddy

et al. 2013

Kidney International Supplements

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The positive impact of a structured deceased-donor program has resulted in a reduction in the number of commercial transplantation operations taking place in India. The engagement of private and government stakeholders has revealed the positive impact of deceased organ donation in India. The best example is the Tamil Nadu state model, where deceased donations have increased to 1.2 per million population compared to the national average of 0.08 per million population. In the last 30 months 994 organs were transplanted. The donation and transplantation in the Government-run hospitals have provided organs to the poor sections of the society free of cost. Immunological surveillance of the prospective recipients remains a challenge, as there is a paucity of immunological laboratories in transplant centers. Generic immunosuppressive drugs manufactured by the local pharmaceutical industry have been shown to be noninferior, and have greatly reduced the cost of achieving immunosuppression.

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Diagnostic efficacy of C4d immunostaining in the detection of the humoral component of renal allograft rejection and therapeutic implications

Abstract: C4d staining is a useful adjunct to routine histopathological methods in evaluating the humoral component of acute renal allograft dysfunction and helps in planning appropriate antirejection therapy with the goal of achieving long-term graft survival.

Cited by 4 publications

References 16 publications

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

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

Renal allograft pathology with C4d immunostaining in patients with graft dysfunction

Evolution of deceased-donor transplantation in India with decline of commercial transplantation: a lesson for developing countries

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