[Pathological diagnosis of renal allograft rejection]

Renal allograft biopsy is essential to confirm the diagnosis of allograft rejection. International classification for allograft pathology (Banff scheme) greatly contributed to make a consensus of clinicopathological context of rejection. Two major pathogenesis of rejection are T-lymphocyte mediated and anti-donor antibody-mediated rejection. Clinical and pathologic diagnostic criteria for antibody-mediated rejection have been well established during the last decade by Banff conference meeting report. Chronic rejection is definite entity from a view point of immunology, and chronic allograft failure is the most important cause of renal graft loss. Strategy to improve the long-outcome of renal allograft is required. However, pathologic diagnostic criteria of immunologic chronic rejection are not well established up to 1995. Recent advances in antibody-mediated rejection showed new insights to differentiate the pathogenesis of chronic rejection. Molecular pathology using DNA array analysis and other new technologies are expected to open new insights to the pathogenesis of renal allograft rejection.