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Renal transplantation serves as an only form of treatment for chronic renal failure patients who became dialysis-dependent because of diseased kidney. We aim to establish the association of histopathological features of rejection with C4d immunohistochemistry results in renal transplant patients in this study. Materials and Methods: 96 renal transplant biopsies were received from patients in department presenting with diagnosis of graft dysfunction. The Banff 2007 grading schema was used to classify histopathological features of rejection and immunostaining for C4d were done on sections. Results: We have received 96 percutaneous allograft renal biopsies for routine histopathological evaluation with Banff scoring and C4d immunostaining. C4d immunohistochemistry in the peritubular capillaries was positive in 13 out of the 96 biopsies examined (13.5%), with focal positivity in 4 cases and diffuse positivity in 9 cases. There was significant association of peritubular capillaries C4d deposition with glomerulitis, peritubular capillaritis, interstitial fibrosis, tubular atrophy, allograft glomerulopathy, arterial fibrointimal thickening, and increase in mesangial matrix, and arteriolar hyalinosis. Conclusion: In the present study C4d deposition in peritubular blood vessels act as a very valuable marker for the diagnosis of humoural rejection. Humoural induced graft injury if left untreated can advance to cause chronic changes like transplant glomerulopathy, atrophy of tubules along with fibrosis of interstitium, and hence leads to graft loss. Its detection in biopsies is simple and inexpensive and can help identify patients who are likely to benefit from anti-humoral therapy. This in turns stop or at least delay subsequent progression to transplant glomerulopathy or chronic rejection. It is concluded that C4d immunostaining deserves a place as a routine marker in the biopsy diagnosis of graft dysfunction and helps in guiding clinical decisions for achiev

Association of c4d deposition in renal allograft biopsy with morphologic features in Banff diagnosis