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Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights
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-l...
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| Format: | Thesis |
| Language: | English English |
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Department of Pathology
2025
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| _version_ | 1867613671661764608 |
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| access_status_str | Open Access |
| author | Lunn, Jarryd |
| author2 | Price, Brendon |
| author_browse | Lunn, Jarryd Price, Brendon |
| author_facet | Price, Brendon Lunn, Jarryd |
| author_sort | Lunn, Jarryd |
| collection | Thesis |
| description | 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. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42407 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:39:51.633Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Pathology |
| publisherStr | Department of Pathology |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42407 Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights Lunn, Jarryd Price, Brendon Chetty, Dharshnee Ikumi, Nadia Renal transplantation Banff 2022 classification renal rejection prevalence rejection biomarkers digital pathology algorithm C4d-DSA prediction Antibody mediated rejection T-cell mediated rejection 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. 2025-12-05T07:14:56Z 2025-12-05T07:14:56Z 2025 2025-12-05T07:12:16Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/42407 en eng application/pdf Department of Pathology Faculty of Health Sciences University of Cape Town |
| spellingShingle | Renal transplantation Banff 2022 classification renal rejection prevalence rejection biomarkers digital pathology algorithm C4d-DSA prediction Antibody mediated rejection T-cell mediated rejection Lunn, Jarryd Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights |
| thesis_degree_str | Master's |
| title | Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights |
| title_full | Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights |
| title_fullStr | Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights |
| title_full_unstemmed | Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights |
| title_short | Renal allograft biopsies at Groote Schuur Hospital: a histopathologic descriptive study with molecular insights |
| title_sort | renal allograft biopsies at groote schuur hospital a histopathologic descriptive study with molecular insights |
| topic | Renal transplantation Banff 2022 classification renal rejection prevalence rejection biomarkers digital pathology algorithm C4d-DSA prediction Antibody mediated rejection T-cell mediated rejection |
| url | http://hdl.handle.net/11427/42407 |
| work_keys_str_mv | AT lunnjarryd renalallograftbiopsiesatgrooteschuurhospitalahistopathologicdescriptivestudywithmolecularinsights |