Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights

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dc.contributor.advisorPrice, Brendon
dc.contributor.advisorChetty, Dharshnee
dc.contributor.advisorIkumi, Nadia
dc.contributor.authorLunn, Jarryd
dc.date.accessioned2025-12-05T07:14:56Z
dc.date.available2025-12-05T07:14:56Z
dc.date.issued2025
dc.date.updated2025-12-05T07:12:16Z
dc.description.abstractBackground: Kidney transplantation is the definitive treatment for end-stage kidney disease. Immune-mediated rejection remains a barrier to success. It is diagnosed through the Banff classification, which incorporates histopathology and biomarkers (C4d/donor specific antibodies (DSA)). In resource-limited settings, DSA testing can be challenging, necessitating reliable alternatives. Aim: This study evaluated: (1) rejection patterns at our hospital; (2) the impact of the Banff 2022 criteria with a computer-assisted tool; and (3) the utility of C4d as a predictor of DSA status. Methods: We analysed 197 for-cause historic biopsy reports between 2015-2022 for details of rejection- and non-rejection pathologies, Banff lesion scores and DSA status. A computer- based tool was used on historic data to re-calculate Banff 2022 classification diagnoses, which were compared to historic diagnoses. Logistic regression assessed C4d as a predictor of DSA. Results: The cohort showed a male predominance (59.3%). Sixty-three percent of cases showed non-rejection pathology, with acute tubular injury and pyelonephritis being the most frequent. TCMR was the most common form of rejection (17.3%), with AMR being the least common (7.6%). The computer-based tool demonstrated agreement of 92.4% for AMR/TCMR and 84.6% of borderline TCMR, but was confounded by non-rejection pathologies. C4d predicted DSA-positivity with 95% specificity but only 29.5% sensitivity. Conclusion: The Banff 2022 criteria were additive in rejection diagnosis, with a computer-based tool acting as a guide but not a pure diagnostic tool. The high specificity of C4d makes it valuable where DSA testing is limited. Contribution: This study validates the role of the Banff 2022 in our setting, aided by a computer-based tool that aims to decrease logical- and transcription errors when using the complex Banff classification. It also demonstrates C4d's role as a practical DSA proxy, offering actionable solutions in resource-limited settings.
dc.identifier.apacitationLunn, J. (2025). <i>Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Pathology. Retrieved from http://hdl.handle.net/11427/42407en_ZA
dc.identifier.chicagocitationLunn, Jarryd. <i>"Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Pathology, 2025. http://hdl.handle.net/11427/42407en_ZA
dc.identifier.citationLunn, J. 2025. Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights. . University of Cape Town ,Faculty of Health Sciences ,Department of Pathology. http://hdl.handle.net/11427/42407en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Lunn, Jarryd AB - Background: Kidney transplantation is the definitive treatment for end-stage kidney disease. Immune-mediated rejection remains a barrier to success. It is diagnosed through the Banff classification, which incorporates histopathology and biomarkers (C4d/donor specific antibodies (DSA)). In resource-limited settings, DSA testing can be challenging, necessitating reliable alternatives. Aim: This study evaluated: (1) rejection patterns at our hospital; (2) the impact of the Banff 2022 criteria with a computer-assisted tool; and (3) the utility of C4d as a predictor of DSA status. Methods: We analysed 197 for-cause historic biopsy reports between 2015-2022 for details of rejection- and non-rejection pathologies, Banff lesion scores and DSA status. A computer- based tool was used on historic data to re-calculate Banff 2022 classification diagnoses, which were compared to historic diagnoses. Logistic regression assessed C4d as a predictor of DSA. Results: The cohort showed a male predominance (59.3%). Sixty-three percent of cases showed non-rejection pathology, with acute tubular injury and pyelonephritis being the most frequent. TCMR was the most common form of rejection (17.3%), with AMR being the least common (7.6%). The computer-based tool demonstrated agreement of 92.4% for AMR/TCMR and 84.6% of borderline TCMR, but was confounded by non-rejection pathologies. C4d predicted DSA-positivity with 95% specificity but only 29.5% sensitivity. Conclusion: The Banff 2022 criteria were additive in rejection diagnosis, with a computer-based tool acting as a guide but not a pure diagnostic tool. The high specificity of C4d makes it valuable where DSA testing is limited. Contribution: This study validates the role of the Banff 2022 in our setting, aided by a computer-based tool that aims to decrease logical- and transcription errors when using the complex Banff classification. It also demonstrates C4d's role as a practical DSA proxy, offering actionable solutions in resource-limited settings. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - Renal transplantation KW - Banff 2022 classification KW - renal rejection prevalence KW - rejection biomarkers KW - digital pathology algorithm KW - C4d-DSA prediction KW - Antibody mediated rejection KW - T-cell mediated rejection LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights TI - Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights UR - http://hdl.handle.net/11427/42407 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42407
dc.identifier.vancouvercitationLunn J. Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights. []. University of Cape Town ,Faculty of Health Sciences ,Department of Pathology, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42407en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Pathology
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectRenal transplantation
dc.subjectBanff 2022 classification
dc.subjectrenal rejection prevalence
dc.subjectrejection biomarkers
dc.subjectdigital pathology algorithm
dc.subjectC4d-DSA prediction
dc.subjectAntibody mediated rejection
dc.subjectT-cell mediated rejection
dc.titleRenal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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