Our approach to a renal transplant biopsy. Issue 1 (22nd October 2009)

• Record Type: Journal Article
• Authors: John, R; Herzenberg, A M
• Is Part Of: Journal of clinical pathology. Volume 63:Issue 1(2010)
• Page Start: 26
• Page End: 37
• Publication Date: 2009-10-22
• Subjects: Pathology -- Periodicals; Pathology, Molecular -- Periodicals; 616.0705
• DOI: 10.1136/jcp.2009.067983
• Languages: English
• ISSNs: 0021-9746

Abstract

Abstract : Kidney transplantation has become increasingly common in major health centres, making renal allograft evaluation through biopsy a common procedure. Early allograft dysfunction occurs in 30–50% of all transplants, while chronic graft failure is almost uniform at a rate of 2–4% a year. Allograft biopsy remains the gold standard for the diagnosis of graft dysfunction. Rejection, albeit the most important, is only one of many causes of allograft dysfunction. The widely accepted Banff classification has set criteria for the diagnosis of acute and chronic rejection. The major differential diagnoses are acute ischaemic injury, calcineurin inhibitor toxicity (acute and chronic), infections, including pyelonephritis and polyomavirus nephropathy, chronic obstruction/reflux, hypertension, and recurrent and de novo disease. In this review, there is an outline of the Banff criteria and their implications, the various causes of graft dysfunction, and a discussion on morphological guidelines towards the various diagnoses.