A Multicentre Study of the Spectrum of Histopathological Changes in Renal Allograft Biopsies Over a Period of 9 Years From India.

Abstract

INTRODUCTION Following renal transplant, graft dysfunction is not uncommon. Assessment of histopathological changes in the allograft rejection is done using the Banff ‘07 Update to the Banff 97 Diagnostic Categories for Renal Allograft Biopsies which is the accepted formulation worldwide. However lack of trained nephropathologists in developing countries is a setback for appropriate management. AIM To evaluate the spectrum of histopathological changes seen in renal allograft biopsies. MATERIALS AND METHOD A retrospective study was done in a tertiary care center in South India. A total of 1151 renal allograft biopsies from 1120 patients (75% males / 25% females with mean age 35 ± 12.57 years) with mean serum creatinine 2.68 ± 1.93 mg/dL were studied over a period of 9 years. All patients were on maintenance immunosuppressants including various combinations of triple drugs comprising steroids, Azothiaprine, CNI, Mycophenolate mofetil (MMF) and M-TOR inhibitors when CNI related toxicity was evident. The biopsies were grouped into six categories according to the Banff ‘07 Update Classification. Statistical analyses were done and the percentages were calculated. RESULTSFigure: No Caption available.Categorization of biopsies into Banff'07 update diagnostic categories.Figure: No Caption available.Split up of non-rejection causes of post transplant renal dysfunction CONCLUSION Among graft dysfunction, ATN was more common followed by chronic T cell rejection, Pyelonephritis, CNI toxicity and IFTA. The appropriate histopathological diagnosis helped in tailoring the immunosuppressive therapy especially in ATN, CNI toxicity and Pyelonephritis.