Pathological Study on Renal Allograft Biopsies -Evaluation of Rejection Cases

Renal transplantation is one of the life-saving modality of treatment for end-stage renal diseases1. Graft rejection and the complications of immunosuppressive therapy continue to be the major causes for allograft loss. The clinical and morphological features on allograft biopsy associated with rejection remains to be learned much2. Consecutive 50 cases whose renal biopsies were done from January 2010 to June 2012 at Aiims, New Delhi were selected randomly and analyzed in respect to clinical, histological and their follow up for 6 months. Out of 50 biopsies, 38 were found to have rejection and among those 19 (38 %) showed combined acute cellular (ACR) and chronic rejection (CR), 11 (22 %) showed only CR and 8 (16 %) showed only ACR.12 biopsies (24 %) were found as non-rejection as per the Banff-2003 and CCTT criteria.3, 4, 5 In our study clinical features alone neither diagnostic nor predictive of acute rejection6. Histological evaluation is considered as most definitive and reliable method for predicting and to diagnose the rejection.7, 8 Even though the grading of ACR is similar with both Banff and CCTT criteria, Banff system found to be valuable in predicting sub clinical, humoral rejection and early chronic rejection.