Renal transplant biopsy: What does it tell?

Current Opinion in Nephrology and Hypertension

Volumn 6, Issue 6, 1997, Pages 538-543

  Solez, Kim ^a,b   Afrouzian, Marjan ^a   Pakasa, Nestor ^a   Takeda, Kazuhito ^a   Trpkov, Kiril ^a  

^a UNIVERSITY OF ALBERTA   (Canada)

^b UNIVERSITY OF ALBERTA   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

DIAGNOSTIC ACCURACY; DIAGNOSTIC VALUE; HUMAN; KIDNEY BIOPSY; KIDNEY GRAFT; KIDNEY GRAFT REJECTION; KIDNEY TRANSPLANTATION; PRIORITY JOURNAL; REVIEW;

EID: 0030785087     PISSN: 10624821     EISSN: None     Source Type: Journal    
DOI: 10.1097/00041552-199711000-00007     Document Type: Review

References (17)

1. Strehlau J, Pavlakis M, Lipman M, Shapiro M, Vasconcellos L, Harmon W, Strom TB: Quantitative detection of immune activation transcripts as a diagnostic tool in kidney transplantation. P roc Natl Acad Sci USA 1997, 94:695-700. This stimulating paper (which is available as full text on the WWW at http://www.pnas.org/cgi/content/full/94/2/695) breaks new ground in the practical application of molecular biology to biopsy-based rejection diagnosis in renal transplantation. All that is lacking for a completely convincing demonstration is a side-by-side comparison with conventional light microscopic morphometry and Banff-Classification-based biopsy interpretation (i.e. in the cases examined, are the molecular biology methods superior to counting lymphocytes on a periodic acid Schiff stain, and is there absolute specificity or does the average positivity per lymphocyte remain the same, the difference between rejection cases and others being the number of lymphocytes?).
2. Solez K, Axelsen RA, Benediklsson H, Burdick JF, Cohen AH, Colvin RB, Croker BP, Droz D, Dunnill MS, Halloran PF et al:. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 1993, 44:411-422.
3. Oliveira JG, Ramos JP, Xavier P, Magalhaes MC, Mendes AA, Guerra LE: Analysis of fine-needle aspiration biopsies by flow cytometry in kidney transplant patients. Transplantation 1997, 64:97-102. This is another demonstration of the diagnostic usefulness of immune activation parameters, here analysed in fine needle aspiration biopsies, which are a much more benign procedure for the patient than conventional percutaneous needle biopsy.
4. Solez K, Racusen LC, Bonsib S, Castro M-C, Cavallo T, Colvin R, Croker B, Demetris AJ, Drachenberg C, Fogo A et al.: Schema for grading tissue. 1997, http://tpis.upmc.edu/tpis/schema/index.html This WWW site contains the tables from the evolving manuscript from the Fourth Banff Conference on Allograft Pathology, 7-12 March, 1997. The emphasis has shifted from grades of rejection to histological types, which have now been shown to have distinctly different outcomes and prognosis. The accuracy of the Banff Classification has been improved in several significant ways. Nevertheless, because the Banff 1993-1995 Classification is so well established and widely used, it will be some time before the full transition to the Banff 1997 classification occurs.
5. Solez K, Benediktsson H, Cavallo T, Croker B, Demetris AJ, Drachenberg C, Emancipators, Furness PN, Gaber LW, Gibson IW et al.: Report of the Third Banff Conference on Allograft Pathology (20-24 July, 1995) on classification and lesion scoring in renal allograft pathology. Transplant Proc 1996, 28:441-444.
6. Gaber LW, Moore LW, Gaber AO, First MR, Guttmann RD, Pouletty P, Schroeder TJ, Soulillou JP: A multicenter report on the utilization of Banff grading in acute renal rejection. The 1995 Efficacy Endpoints Conference. Transplant Proc 1997, 29:184-185. Further details on the presentation of this work by Gaber et al. at the Fourth Banff Conference on Allograft Pathology, 7-12 March, 1997, are provided on the CD-ROM from that meeting, which is edited by Solez K and Racusen LC and available from Churchill Livingstone Inc., New York.
7. Furness PN, Kirkpatrick U, Taub N, Davies DR, Solez K: A UK-wide trial of the Banff Classification of renal transplant pathology In routine diagnostic practice. Nephrol. Dial Transplant 1997, 12: 995-1000. A very interesting UK-wide assessment of the Banff Classification is provided. A discussion of this work and the neural network approach to rejection diagnosis can be found at the following WWW addresses: http://www.med.ualberta.ca/isn;000i011f.htm and http://www.his.path.cam.ac.uk/mirrors/isn/000i011f.htm
8. Olsen S, Hansen HE, Madsen M: Studies of the clinical value of the Banff grading of acute rejection. 1997, http://www.med.ualberta.ca/isn/000i011h.htm and http://www.his.path.cam.ac.uk/mirrors/isn/000i011h.htm Rejection characterized by intimal arthritis without fibrinoid change or transmural inflammation has a significantly worse outcome than does rejection characterized by tubulitis only.
9. Rush D: The significance of subclinical rejection. 1997, http://www.med.ualberta.ca/isn/000i011l.htm and http://www.his.path.cam.ac.uk/mirrors/isn/000i011l.htm This work demonstrates for the first time that 'subclinical rejection' occurring in grafts with normal function is eventually tied to scarring of the graft and renal functional impairment, suggesting that it deserves treatment and does not simply constitute a 'false positive' reading and a flaw in the classification.
10. Tsamandas AC, Shapiro R, Jordan M, Demetris AJ, Randhawa PS: Significance of tubulitis In chronic allograft nephropathy: a clinicopathologic study. Further confirmation of clinical significance of tubulitis. Clin Transplant 1997, 2:139-141.
11. Kon SP, Templar J, Dodd SM, Rudge CJ, Raftery MJ: Diagnostic contribution of renal allograft biopsies at various intervals after transplantation. Transplantation 1997, 63:547-550.
12. Monga G, Mazzucco G, Messina M, Motta M, Quaranta S, Novara R: Intertubular capillary changes in kidney allografts: a morphologic investigation on 61 renal specimens. Mod Pathol 1992, 5:125-130.
13. Morozumi K, Oikawa T, Fukuda M, Sugito K, Takeuchi O, Usami T, Fujinami T, Yokoyama I, Takagi H, Takeda A. et al.: Electron-microscopic peritubular capillary lesion is a specific and useful diagnostic indicator for chronic rejection of renal allografts showing less specific morphologic lesions in the cyclosporine era. Transplant Proc 1997, 29:89-92. Further support for the specificity of this lesion for chronic rejection is provided.
14. Laine J, Etelämäki P, Holmberg C, Dunkel L: Apoptotic cell death in human chronic renal allograft rejection. Transplantation 1997, 63:101-105. This is an intriguing observation that needs confirmation with a transplant biopsy control group.
15. Halloran P, Mathew T, Tomlanovich S, Groth C, Hooptman L, Barker C: Mycophenolate mofetil in renal allogratt recipients. Transplantation 1997, 63:39-47.
16. Kendrick EA, McVicar JP, Kowdley KV, Bronner MP, Emond MJ, Alpers CE, Greth DR, Caruthers RL Jr, Perkins JD, Davis CL: Renal disease in hepatitis C-positive liver transplant recipients. Transplantation 1997, 63:1287-1293.
17. Morales JM, Pascual-Capdevila J, Campistol JM, Femandez-Zatarain G, Muñoz MA, Andres A, Praga M, Martinez MA, Usera G, Fuertes A et al.: Membranous glomerulonephritis associated with hepatitis C virus infection in renal transplant patients. Transplantation 1997, 63:1634-1639. This is perhaps a very interesting observation exploring some cases of de-novo membranous glomerulopathy. The findings need confirmation from other centres.