Introduction: Kidney transplantation stands as a crucial intervention for end-stage renal disease (ESRD) in India, where the burden of this condition is significant. Despite advancements, graft dysfunction remains a challenge, affecting survival rates. Renal allograft biopsy is crucial for diagnosis and treatment guidance. Our study aims to analyze biopsy outcomes comprehensively, emphasizing the significance of timely biopsies. We seek to examine histopathological patterns to enhance the management of renal allograft dysfunction and improve patient outcomes by understanding their predictive relevance to graft and patient outcomes.
Method: Our retrospective study analyzed percutaneous renal allograft biopsies at a central Indian tertiary care hospital from January 1, 2023, to February 29, 2024. Data from patient records included medical histories, transplant progress, and biopsy indications. Experienced nephrologists performed guided biopsies. Biopsy reports were compared to Banff criteria-based clinical diagnoses. We examined demographics, donor characteristics, underlying reasons for ESRD, C4d status, and histopathological findings. A single pathologist evaluated all biopsies. Our objectives were identifying factors contributing to graft dysfunction, classifying pathology per Banff criteria, and conducting statistical analyses.
Results: Over 14 months, 17 biopsies were performed on 13 patients. The mean age of our patient cohort was 37.00 ± 10.47 years, with a predominant representation of male patients (88.2%). Acute tubular injury (ATI) (29.4%) was the most prevalent histological diagnosis, followed by antibody-mediated rejection (ABMR) at 23.5%. Notably, among patients diagnosed with rejection, ABMR constituted the most frequent histological diagnosis at 40%. Deceased donor recipients constituted 52.9% of cases and live 47.1%. Positive C4d staining was seen in 41.2% of graft biopsies, with ABMR being the most prevalent finding (57.1%) in these cases. Graft dysfunction emerged as the primary indication for biopsy in 58.8% of cases, followed by graft dysfunction with proteinuria in 41.2%. ATI was the most prevalent histological finding in 40% of biopsies conducted due to graft dysfunction. Conversely, ABMR emerged as the predominant histological diagnosis among cases featuring graft dysfunction and proteinuria at 28.6%.
Conclusion: Renal allograft biopsy is pivotal in evaluating kidney transplant dysfunction and guiding treatment decisions. Our study highlights a significant predominance of ATI as the primary histological diagnosis, followed by ABMR. Notably, ABMR emerges as a notably prominent entity among cases of rejection. Timely biopsies are advocated to ensure precise diagnosis and improve patient outcomes. Recognizing diverse histological patterns is crucial for effective management, emphasizing the importance of biopsy in optimizing allograft survival by avoiding unnecessary treatments.