Study of insect succession and rate of decomposition on a partially burned pig carcass in an oil palm plantation in Malaysia

Insects found associated with corpse can be used as one of the indicators in estimating postmortem interval (PMI). The objective of this study was to compare the stages of decomposition and faunal succession between a partially burnt pig (Sus scrofa Linnaeus) and natural pig (as control). The burning simulated a real crime whereby the victim was burnt by murderer. Two young pigs weighed approximately 10 kg were used in this study. Both pigs died from pneumonia and immediately placed in an oil palm plantation near a pig farm in Tanjung Sepat, Selangor, Malaysia. One pig was partially burnt by 1-liter petrol while the other served as control. Both carcasses were visited twice per day for the first week and once thereafter. Adult flies and larvae on the carcasses were collected and later processed in a forensic entomology laboratory. Results showed that there was no significant difference between the rate of decomposition and sequence of faunal succession on both pig carcasses. Both carcasses were completely decomposed to remain stage after nine days. The species of flies visiting the pig carcasses consisted of blow flies (Chrysomya megacephala, Chrysomya rufifacies, Hemipyrellia ligurriens), flesh fly (Sarcophagidae.), muscid fly (Ophyra spinigera), soldier fly (Hermetia illucens), coffin fly (Phoridae) and scavenger fly (Sepsidae). The only difference noted was in the number of adult flies, whereby more flies were seen in the control carcass. Faunal succession on both pig carcasses was in the following sequence: Calliphoridae, Sarcophagidae, Muscidae, Phoridae and lastly Stratiomyidae. However, there was overlap in the appearance of members of these families. Blowflies continued to oviposit on both carcasses. Hence postmortem interval (PMI) can still be estimated from the partially burnt pig carcass.

First report of maggots of family Piophilidae recovered from human cadavers in Malaysia

Piophila casei (Linnaeus) (Diptera: Piophilidae) is reported from human cadavers in two separate forensic cases for the first time in Malaysia. Both bodies were found indoors. The first case, was that of a male of unknown nationality and age and also contained maggots of the muscid Ophyra spinigera (Stein). The second case was a female Chinese whose body also contained other species of maggots but these were not identifiable.

Distribution and abundance of diurnal and nocturnal dipterous flies in the Federal Territory, Putrajaya

A study of diurnal and nocturnal distribution of flies was conducted in Putrajaya. Six different ecological habitats were selected, namely: botanical garden, lake-area, administration building, wetland, jungle fringes and housing areas. Two different type of traps, cylinderical and rectangular in shape were used in the study. Baits used in these traps were yeast, sugar, salted fish, shrimp paste and fresh liver. Traps were placed at the sites throughout the diurnal and nocturnal periods. The time for sunrise and sunset was determined using a Geographical Positioning System gadget (GARMIN) at the sites. Both type of traps were equally effective in trapping flies. There was no significant difference between both types of traps in their ability to trap flies (p > 0.05). A total of 1,534 flies were collected and identified from both types of trap using the multiple baits and habitats. The collection consisted of 23 species of flies classified under 6 families. The highest number of flies were caught from the lake-area followed by botanical garden, administration building, housing areas, wetland and jungle fringes. The most dominant species was Chrysomya megacephala, followed by species of Sarcophagidae and Musca domestica. Diurnal period had more numbers of flies (81.55%) compared to the nocturnal periods (18.45%). Some species of flies were strictly diurnal, some exibited both diurnal and nocturnal activities while only one species was strictly nocturnal.

Four cases of pediculosis caused by Pthirus pubis Linnaeus, 1758 (Diptera: Anoplura) from peninsular Malaysia

Four cases of pediculosis, two in adults and two in children, caused by the crab-louse, Pthirus pubis Linnaeus, 1758 (Diptera: Anoplura) is reported from peninsular Malaysia. This is the second report of the problem to be documented from the country. Although P. pubis is closely associated with genital hairs, it is, however, also found to occur on the eyelashes, eyebrows, hairs of the body, head and axilla. The few reported cases of pthiriasis probably do not reflect the true situation.

A preliminary study of insect succession on a pig carcass in a palm oil plantation in Malaysia

This preliminary study was carried out in a palm oil plantation in Tanjung Sepat, Selangor in 17 May 2007 by using pig (Sus scrofa) as a carcass model in forensic entomological research. A 3 month old pig (8.5 kg) that died of pneumonio was placed in the field to observe the decomposition stages and the fauna succession of forensically important flies. Observation was made for two weeks; two visits per day and all climatological data were recorded. The first visitor to the pig carcass was a muscid fly, seen within a minute, and followed by ants and spiders. Within half an hour, calliphorid flies came over. On the second day (fresh), few calliphorid and sarcophagid flies were found on the carcass. Two different species of moths were trapped in the hanging net. The first larva mass occurred on the third day (bloated) around the mouthpart, with some L1 and L2 found in the eyes. Reduvid bugs and Staphylinidae beetles were recovered on the fourth day (active decay), and new maggot masses occurred in the eyes and anus. L3 larvae could be found beneath the pig carcass on the fourth day. On the fifth day (active decay), new maggot masses were found on neck, thorax, and hind legs. Advance decay occurred on the sixth day with abundant maggots covering all over the body. The main adult fly population was Chrysomya megacephala (day 2 to day 6), but the larvae population was mainly those of Chrysomya rufifacies (day 4 to day 14). The dry stage began on the eighth day. Hermetia illucens adult was caught on day-13, and a larvae mass of Chrysomya rufifacies was seen burrowing under the soil. This forensic entomological research using pig carcass model was the first record in this country.

A new record of Fannia pusio (Wiedemann) (Diptera:Fanniidae) from Malaysia

Fannia pusio (Wiedemann) (Diptera: Fanniidae) is newly recorded from Malaysia. This record is based on 1male symbol 1female symbol from Sarawak, east Malaysia and 1male symbol 2female symbol from Selangor, peninsular Malaysia. It is included in the pusio group of Fannia wherein are included Fannia femoralis (Stein), Fannia howardi Malloch, Fannia trimaculata (Stein), Fannia leucosticta (Meigen) and Fannia punctiventris Malloch. The male of Fannia pusio is differentiated from other members of the group by the following features: hind femur with a swelling bearing a number of setae that are usually curled at tip; squamae creamy; tergite 1+2 broadly grey dusted at sides.

Notes on some ectoparasites received by the Medical Entomology Unit, Institute for Medical Research

There were a spate of recent complaints of insect bites and the entomological specimens received from various sources were identified to be those of cat flea (Ctenocephalides felis) and rat flea (Xenopsylla cheopis), the tropical bed-bug (Cimex hemipterus) and the dog louse (Heterodoxus spiniger). Only the fleas and the bed-bug are known to attack humans.

Species composition of mosquitoes of Attapeu Province, Lao People's Democratic Republic

A list of mosquitoes collected from Lao People's Democratic Republic (Lao PDR) from May 2002 to August 2004 is presented. A total of 8,945 mosquitoes belonging to 14 genera and 57 species was collected. The genera recorded were Aedes, Anopheles, Armigeres, Coquillettidia, Culex, Diceromyia, Downsiomyia, Fredwardsius, Mansonia, Neomelaniconion, Ochlerotatus, Paraedes, Stegomyia, and Verrallina. Seventeen species are first reports for LAO PDR.

A comparative study of adult mosquito trapping using dry ice and yeast generated carbon dioxide

Adult mosquito collections were conducted for 12 weeks in two residential areas in Kuala Lumpur. The CDC light traps were compared using dry ice and yeast as sources of carbon dioxide attractants for mosquitoes. The efficacy of the dry ice baited trap was significant over yeast generated CO2 trap. The predominant species obtained were Culex quinquefasciatus, Stegomyia albopicta and Armigeres subalbatus.

Bacteria fauna from the house fly, Musca domestica (L.)

The house fly, Musca domestica has long been considered a potential agent for disease transmission ever since its existence. The general truth of this assertion remains undisputed till the present day in spite of increasing awareness toward an improved sanitation and better hygiene. The habitual movement of house fly from filthy substrata such as human faeces, animal excreta, carcasses, garbage, etc. makes them ideal candidates for disease transmission such as cholera, shigellosis, salmonellosis and others when settling on food. Fly as a potential mechanical vector of pathogenic bacteria was elucidated in this study by examining flies from various breeding sites such as food courts, dumping ground, food processing areas and poultry farm in Peninsular Malaysia. The flies were baited with 10% sugar solution on a glass slide in the field. All materials used for collection of samples were sterile. Bacteria from fly sample were isolated using the normal isolation technique. Bacillus sp., Coccobacillus sp., Staphylococcus sp., Microccus sp., Streptococcus sp., Acinetobacter sp., Enterobacter sp., Proteus sp., Escherichia sp., Klebsiella sp. and yeast cells were isolated from feaces, vomitus, external surfaces and internal organs of house fly. Newly emerged house fly did not harbour any bacteria.

Late recurrence of scleroderma renal crisis in a renal transplant recipient despite angiotensin II blockade

Scleroderma renal crisis is the most severe renal manifestation of scleroderma and has been reported to recur rarely early after renal transplantation. Angiotensin II blockade is critical in preventing and treating scleroderma renal crisis, but some concern exists as to whether angiotensin II receptor blockers are clinically equivalent to angiotensin-converting enzyme inhibitors. The current case indicates that late recurrences of scleroderma renal crisis are possible in renal transplant recipients and that angiotensin-converting enzyme inhibitors, rather than angiotensin II receptor blockers, may be the superior drugs for such patients.

Long-term deterioration of kidney allograft function

Although long-term survival after kidney transplantation is critically dependent on maintaining stable allograft function, few studies have examined renal allograft function over time. Using pooled data from 10 278 consecutive transplants at five centers, we calculated slopes of estimated glomerular filtration rates (eGFR) measured after 1, 6 and 12 months in 9515, 8861 and 7359 patients surviving > or =1, > or =6 and > or =12 months, respectively. Slopes of eGFR progressively diminished for patients transplanted during 1984-1989, 1990-1993, 1994-1998 and 1999-2002 (analysis of variance p < 0.0001 and p = 0.1245 for slopes measured after 1 and 6 months, respectively). Slopes measured after 12 months were less in the most recent era: -2.2 +/- 7.2 mL/min/1.73 m(2)/year, -2.3 +/- 6.6 mL/min/1.73 m(2)/year, -2.4 +/- 7.4 mL/min/1.73 m(2)/year and -1.4 +/- 10.9 mL/min/1.73 m(2)/year, respectively, p = 0.0058. Slopes measured after 1, 6 and 12 months each were less for transplantations during 1999-2002, after adjusting for multiple transplantation characteristics (p < 0.0001). Similarly, in Cox proportional hazards analysis, the risk (95% CI) for a 25% reduction in eGFR was 0.92 (0.85-1.01), p = 0.0736 during 1990-1994; 0.94 (0.82-1.08), p = 0.4111 during 1995-1998 and 0.78 (0.64-0.95), p = 0.0110 during 1999-2002 (compared to 1984-1989). We conclude that the rate of decline in allograft function after kidney transplantation has improved, suggesting that stable, long-term function may be achievable.

A fatal case of anaphylactic shock caused by the lesser banded hornet, Vespa affinis indosinensis in peninsular Malaysia

The hornets are a group of venomous stinging insects that at times cause human death. A fatal case of a child stung by the lesser banded hornet Vespa affinis indosinesis is reported. Though often covered by the mass media, this constitutes the first scientifically reported case.

The Relative Importance of Cytokine Gene Polymorphisms in the Development of Early and Late Acute Rejection and Six-Month Renal Allograft Pathology

BACKGROUND

Acute rejection episodes and 6-month protocol biopsy acute pathology are highly correlated with long-term outcomes in renal transplant recipients. Recurrent, vascular, and late rejections are particularly deleterious.

METHODS

We determined the relative contribution of human leukocyte antigen matching, cytokine genotypes, delayed graft function (DGF), and baseline immunosuppression to the development of acute rejection and allograft pathology in 118 renal transplant recipients.

RESULTS

Multivariate logistic regression modeling demonstrated that the adjusted odds ratio and 95% confidence interval for recurrent (> or =2) early rejections (0-3 months) increased linearly for high (H) > intermediate (I) > low (L) interferon-gamma (1.8; 1.1-3.2) and tumor necrosis factor (TNF)alpha (3.0; 1.3-6.9) genotype, whereas every 1 microg/L increase in the cyclosporine A level was protective (0.991; 0.984-0.999). The odds ratio for recurrent late rejections (4-6 months) increased for H > I > L TNFalpha (5.1; 1.8-14.7) genotype and DGF (7.1; 1.6-30.2), whereas H > I/L transforming growth factor-beta1 genotype decreased the relative risk (0.09: 0.02-0.49). Vascular rejection was only predicted by H > I > L TNFalpha phenotype (3.0; 1.2-7.9). The odds ratio for the 6-month Banff Acute Score (6A > or= 4) increased for H > I > L TNFalpha (2.7; 1.1-6.7) and interleukin-10 (3.4; 1.2-6.2) genotype, and DGF (3.4; 1.1-11.5). Treatment of early subclinical rejection decreased the relative risk (0.20; 0.07-0.62).

CONCLUSIONS

High transforming growth factor-beta1 producer phenotype seems to be protective against acute inflammation, whereas H and I interferon-gamma, TNFalpha, and interleukin-10 producer genotypes correlate with adverse outcomes. Cytokine genotyping identifies individuals who may benefit from more intensive surveillance and treatment posttransplant.

Review of forensically important entomological specimens in the period of 1972 - 2002

Forensic entomological specimens received by the Unit of Medical Entomology, IMR., from hospitals and the police in Malaysia in the last 3 decades (1972 - 2002) are reviewed. A total of 448 specimens were received. From these, 538 identifications were made with the following results: Eighteen species of cyclorrphaga flies were identified consisting of Chrysomya megacephala (Fabricius) 215 cases (47.99%), Ch. rufifacies (Masquart) 132 (29.46%), Ch. villeneuvi Patton 10 (2.23%), Ch. nigripes Aubertin 7 (1.56%), Ch. bezziana Villeneuve 4 (0.89%), Ch. pinguis (Walker) 1 (0.22%), Chrysomya sp. 47 (10.49%), Sarcophaga sp. 28 (6.25%), Lucilia sp. 21 (4.69%), Hermetia sp. 15 (3.35%), He. illucens (Linnaeus) 1 (0.22%), Hemipyrellia ligurriens (Wiedemann) 3 (0.67%), Hemipyrellia sp. 2 (0.45%), Ophyra spinigera 1 (0.22%), Ophyra sp. 6 (1.34%), Calliphora sp. 24 (5.36%), Synthesiomyia nudiseta (Wulp) 1 (0.22%) and Eristalis sp. 1 (0.22%). Other non - fly insect specimens are Pthirus pubis (Linnaeus) (Pubic louse) 2 (0.45%) and Coleoptera (Beetles) 1 (0.22%). Ch. megacephala and Ch. rufifacies were the commonest species found in cadavers from different ecological habitats. Sy. nudiseta is an uncommon species, thus far found only on cadavers from indoors. Sy. nudiseta is reported for the second time in Peninsular Malaysia. A total of 329 cases (73.44%) had a single fly infestation, 109 cases (24.33%) had double fly infestation and 10 cases (2.23%) had triple fly infestation. Five cases (1.12%) had eggs and 3 cases (0.67%) had larval stages that were not identifiable. No arthropods were retrieved from cadavers in 8 cases (1.79%). In conclusion, although large number of fly species were found on human cadavers, the predominant species are still those of Chrysomya.

Proteomic-based detection of urine proteins associated with acute renal allograft rejection

At present, the diagnosis of renal allograft rejection requires a renal biopsy. Clinical management of renal transplant patients would be improved by the development of non-invasive markers of rejection that can be measured frequently. This study sought to determine whether such candidate proteins can be detected in urine using mass spectrometry. Four patient groups were rigidly defined on the basis of allograft function, clinical course, and allograft biopsy result: acute clinical rejection group (n = 18), stable transplant group (n = 22), acute tubular necrosis group (n = 5), and recurrent (or de novo) glomerulopathy group (n = 5). Urines collected the day of the allograft biopsy were analyzed by mass spectrometry. As a normal control group, 28 urines from healthy individuals were analyzed the identical manner, as well as 5 urines from non-transplanted patients with lower urinary tract infection. Furthermore, sequential urine analysis was performed in patients in the acute clinical rejection and the stable transplant group. Three prominent peak clusters were found in 17 of 18 patients (94%) with acute rejection episodes, but only in 4 of 22 patients (18%) without clinical and histologic evidence for rejection and in 0 of 28 normal controls (P < 0.001). In addition, the presence or absence of these peak clusters correlated with the clinicopathologic course in most patients. Acute tubular necrosis, glomerulopathies, lower urinary tract infection, and cytomegalovirus viremia were not confounding variables. In conclusion, proteomic technology together with stringent definition of patient groups can detect urine proteins associated with acute renal allograft rejection. Identification of these proteins may prove useful as non-invasive diagnostic markers for rejection and the development of novel therapeutic agents.

One-year posttransplant renal function is a strong predictor of long-term kidney function: results from the Neoral-MOST observational study

BACKGROUND

Peritransplant risk factors influence short-term and long-term graft survival, and 1-year serum creatinine is known to predict long-term graft survival. To examine interrelationships between risk factors, renal function at 1 year, and long-term graft function in patients maintained on cyclosporine, we analyzed data collected from 10,692 de novo or maintenance renal transplant recipients in an ongoing international, prospective, observational study--Neoral-MOST (Multinational Observational Study in renal Transplantation). The effect of donor age, delayed graft function, acute rejection, donor type, panel-reactive antibodies, and previous graft on 1- and 5-year renal function and their relationship to 1-year serum creatinine was assessed.

RESULTS

Donor age, delayed graft function, acute rejection, and donor type significantly increased the risk for serum creatinine > 130 micromol/L at 1 year posttransplant, and 1-year serum creatinine was the strongest predictor of 5-year renal function. After adjustment for 1-year serum creatinine, an ongoing influence was observed for donor age, donor type, and previous graft. Delayed graft function and acute rejection had a significant effect on serum creatinine at year 1 but no additional impact on long-term graft function.

CONCLUSIONS

Serum creatinine at 1 year is influenced by risk factors known to affect overall graft survival and is predictive of 5-year renal graft function. The effects of delayed graft function and acute rejection appear to be limited to their influence on serum creatinine at 1 year, whereas donor type and previous graft predominantly affect later stages of graft life.

Computerized image analysis of Sirius Red-stained renal allograft biopsies as a surrogate marker to predict long-term allograft function

Chronic allograft nephropathy (CAN) is a major problem in posttransplant management. The lack of a reliable and early surrogate marker of CAN has hampered patient care and research. In this study, the Cortical Fractional Interstitial Fibrosis Volume (V(IntFib)), quantitated with computerized image analysis of Sirius Red-stained protocol biopsies, was examined as a potential surrogate for time to graft failure (TTGF) in 68 renal allograft recipients. At 6 mo posttransplant, V(IntFib) was highly correlated with TTGF (r = 0.64, P < 0.001). Both the Banff Chronic Sum and the Acute Sum Scores were also correlated with TTGF, but less strongly (r = 0.28, P < 0.02; r = 0.35, P < 0.003, respectively). As V(IntFib) was not correlated with the Banff Chronic Score, a multivariate model was created that incorporated V(IntFib) and both Acute and Chronic Banff pathology. This model was highly correlated with TTGF (r = 0.7, P < 0.0001). These findings suggest that V(IntFib) determined by computerized image analysis of Sirius Red-stained protocol biopsies at 6 mo posttransplant, with or without incorporation of Banff acute and chronic scoring, may provide an early surrogate for time to graft failure in renal allograft recipients.

Homogeneous Zinc (II) Catalysis in Accelerated Vulcanization: V. The Prevailing Mechanism of Crosslink Formation in Mercaptobenzothiazole Systems

This paper reports a detailed investigation of the molecular mechanism of crosslink formation in sulfur vulcanization accelerated by mercaptobenzothiazole accelerators, such as bis(mercaptobenzothiazolato)zinc(II) (ZMBT), mercaptobenzothiazole disulfide (MBTS) and N-cyclohexyl-2-benzothiazole sulfenamide (CBS). First, the current state of knowledge regarding the mechanism of crosslink formation in these systems is briefly reviewed.

Subsequently, Reaction-Stage Modeling experiments are reported with the model-crosslink precursor (2,3-dimethyl-2-butene-1-yl)(mercaptobenthiazolato)sulfide (dmb-S2-Bt). These experiments reveal that in the presence of bis(cyclohexylamine)bis(mercapto benzo-thiazolato)zinc(II) (ZMBT·(H2NC6H11)) the precursor dmb-S2-Bt is transformed into a disulfidic crosslink and MBTS via symmetric disproportionation reactions. Also sulfuration and isomerization reactions, leading to a hitherto unknown type of pendent group, namely 2-(2,3-dimethyl-2-buten-1-yl)-1,2-benzisothioazolin-3-thione, were shown to occur. The zinc-amine complex was found to have a pronounced catalytic effect on the crosslink reaction; in its absence, hardly any crosslinks are formed. Reactions performed in the presence of additional MBTS showed an inhibitory effect on crosslink formation, suggesting that the disproportionation reaction is in fact an equilibrium reaction. Indeed, it appeared possible to transform disulfidic model crosslinks into crosslink precursors in the presence of both MBTS and the ZMBT-amine complex. These results have lead to determine the prevailing mechanism by which crosslinks are formed during mercaptobenzothiazole vulcanization, namely through an equilibrated, ZMBT-catalyzed disproportionation reaction of crosslinks precursors. This mechanism not only explains the observations in the present model study, but is also in line with results obtained earlier in real rubber experiments.

Electrocardiographic left ventricular hypertrophy in renal transplant recipients: prognostic value and impact of blood pressure and anemia

Left ventricular hypertrophy (LVH) is an independent risk factor for death and cardiovascular disease in the general population and dialysis patients. However, the causes and consequences of LVH have not been well described in renal transplant recipients (RTR). A retrolective cohort study was conducted in 473 RTR who were alive and free of cardiac disease at 1 yr. LVH was defined using the Cornell electrocardiographic (EKG) criteria. A total of 416 patients had an interpretable first-year EKG (88%), and 284 had an interpretable fifth-year EKG (78% of 5-yr survivors). Baseline characteristics were similar in patients with and without EKG. Of 416 patients, 57 had LVH in the first year, whereas 38 of 284 patients had LVH in the fifth year, of which 18 cases were de novo. Baseline LVH was a risk factor for death (RR 1.9 [1.22, 3.22]) and congestive heart failure (CHF) (RR 2.27 [1.08, 4.81]) and was independent of other major prognostic variables. Persistent or de novo LVH in the fifth year predicted subsequent death (RR 2.15 [1.14,4.01]) and CHF (2.71 [1.17, 6.30]). Anemia and diastolic BP were independent risk factors for increasing Cornell voltage (a marker of LV mass) between first and fifth years. Systolic BP was the only predictor of de novo LVH at 5 yr. It seems that EKG LVH is a significant risk factor for death and CHF in RTR and that anemia and hypertension are risk factors for LV growth. Whether aggressive treatment of hypertension and anemia can improve outcomes merits further study.

Heightened peripheral blood lymphocyte CD69 expression is neither sensitive nor specific as a noninvasive diagnostic test for renal allograft rejection

It has been reported that acute allograft rejection is associated with heightened expression of the peripheral blood lymphocyte (PBL) early activation marker CD69 and that this may serve as a potential biomarker of rejection. This study sought to determine whether PBL CD69 expression correlates with both acute clinical and subclinical renal allograft rejection as well as clinically inapparent cytomegalovirus (CMV) infection. Flow cytometric determination of PBL CD69 expression was performed at the time of clinical and protocol biopsies (n = 131) in 45 renal transplant recipients. Nineteen patients also underwent weekly monitoring of PBL CD69 expression for the initial 15 wk after transplantation. Simultaneous screening for CMV viremia was performed with a semiquantitative PCR assay. No differences were seen in either CD4+ or CD8+ lymphocyte CD69 expression between the biopsy diagnoses. CMV viremia however, independent of rejection, was associated with greater CD69 expression on CD8+ lymphocytes (17.8 +/- 10.4% versus 9.6 +/- 4.8%; P < 0.0001) but not CD4+ lymphocytes. No individuals experienced clinical CMV disease. Weekly monitoring of PBL CD69 expression did not change coincident with the diagnosis of rejection; however, CMV viremia coincided with a substantial rise in the proportion of CD8+69+ lymphocytes in a number of individuals. Thus, PBL CD69 expression is neither sensitive nor specific for the noninvasive diagnosis of renal allograft rejection. Furthermore, clinically inapparent CMV viremia is associated with heightened expression of this activation marker on CD8+ lymphocytes. This latter finding suggests that clinically inapparent CMV viremia may be a potential confounder for biomarkers of rejection that examine peripheral blood lymphocytes.

Reproducibility of the Banff schema in reporting protocol biopsies of stable renal allografts

BACKGROUND

There is evidence that biopsy of stable renal allografts may be of value in predicting chronic allograft nephropathy, the main cause of graft loss. However, the reproducibility of such histological evaluation has not been tested in this setting. We tested the reproducibility of the Banff schema for this purpose.

METHODS

We rated acute and chronic changes in 184 protocol biopsies. Individual pathologists at two different Canadian transplant centres reported independently.

RESULTS

There was agreement in 73.53, 42.86, and 77.08% of cases in assigning a diagnosis of acute rejection, borderline changes (as defined in the schema), and no acute rejection, respectively. Applying kappa statistics, there was very good agreement in making the diagnosis of acute rejection vs no acute rejection (kappa 0.77). There was good inter-observer agreement in scoring glomerulitis, intimal arteritis, interstitial infiltrates, tubulitis, and arteriolar hyalinosis. Rating chronic changes also gave good inter-observer agreement (kappa=0.53, 0.65, and 0.62, respectively, for mild, moderate, and severe chronic allograft nephropathy). Agreement on transplant glomerulopathy was, however, poor.

CONCLUSIONS

We conclude that the Banff classification provides a reproducible method for the histological assessment of protocol renal allograft biopsies in stable grafts. Such biopsies may be valuable in detecting subclinical rejection and early chronic allograft nephropathy and may also be used as surrogate end-points in the evaluation of therapy to prevent the latter.