Introduction: Recipients of incompatible renal allografts remain at risk of developing AMR after transplantation. Current microarray analysis of allograft biopsies showed similar disturbances in AMR and TCMR, suggestive of significant T cell involvement in AMR. It is also known that glomerular margination of leucocytes occur early after transplantation and was associated with DSA level and early graft dysfunction. Aim was to determine the significance of increased number of CD45 positive cells in predicting rejection.

Methods:45 sensitized patients, 43 to HLA antigens and 2 to both HLA and ABO antigens. Graft biopsies were done 30 minutes after perfusion. CD45 Immunostaining on sections was done. CD45 positive cells were counted manually under high resolution microscope, looking at the total number in one glomeruli and the average CD45 count. Reporting of the slides was according to the Banff 2007 criteria. Subsequent biopsies were scored and were looked in for rejection, AMR or TCMR.

Results: 45 Patients:18M, 27F. 23/45 had rejection, both AMR and TCMR. 11 patients developed AMR, with 8 developing TCMR within 3 months after transplantation. 68.75% patients who developed rejection, both AMR and TCMR, had an initial CD45 cell count >5, with only 37.93% developing rejection with CD45 cell count <5(p=0.04). With the type of rejection less than 3 months after transplantation, 32.25% had TCMR with 37.5% developing AMR when the CD45 cell count was >5, with only 10.34% developing TCMR and 17.24% developing AMR with CD45 cell count <5(p=0.02). Patients with t2 tubulitis on graft biopsy had a higher mean average CD45 of 12.15±7.34 than t1 with mean CD45 of 2.55±1(p=0.003) and t0 mean CD45 cell count 4.30±1.8(p=0.01).Patients with v2 intimal arteritis on biopsy had a higher mean average CD45 of 15.6±1 than v1 with mean CD45 of 2.82±1.13(p=0.0017) and v0 mean CD45 cell count 4.82±1.9(p=0.029).

Conclusions: An average of five or more CD45 positive cells in the post perfusion graft biopsy was significantly associated with rejection, both AMR and TCMR. Higher the average CD45 cell count and the total count in one glomeruli, greater is the chance of developing rejection, AMR and TCMR, in the immediate post transplant period. Initial highest CD45 count in a single glomeruli and a greater average CD45 count is associated with a greater risk of developing tubulitis and intimal arteritis later. This outcome depicts the importance of CD45 immunostaining in predicting both AMR and TCMR.

CITATION INFORMATION: Yuvaraj A, Prasad A, Gopalakrishnan K, Krishnan N. Glomerular CD45 Immunostaining in Post Perfusion Graft Biopsies Predicting Rejection. Am J Transplant. 2017;17 (suppl 3).

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