[The pivotal role of the pathologist in transplantation]

The management of rejection has recently become more complex, in particular since the identification of antibody-mediated rejection in addition to the full-established pictures of cellular rejection. The pathologist who reads graft biopsies must solve these problems in order to arrive at a clear histopathological diagnosis. The diagnosis will then have to be discussed in a multidisciplinary approach with the clinical persons, in order to decide upon the optimal treatment approach. Protocol biopsies may detect subclinical rejection and, hence help adjust the immunosuppressive treatment for an extended allograft survival. Finally, allograft biopsies performed with the purpose of "staging" may yield helpful informations concerning the condition of the organ, and may thus help to anticipate a possible future re-transplantation.