Protocol graft biopsy in kidney transplantation

Area of Science:

• Nephrology
• Transplant Pathology
• Immunology

Background:

• Renal allograft biopsy interpretation is vital for therapeutic decisions, particularly for graft rescue.
• Protocol biopsies monitor baseline conditions, subclinical rejection, immunosuppression effects, drug toxicity, infections, and glomerulonephritis recurrence.
• Semiquantitative scoring of active lesions (tubulitis, glomerulitis, etc.) and polyomavirus infection are critical in transplant pathology.

Purpose of the Study:

• To review the interpretation of renal transplant pathology.
• To cover rejection, infection, glomerulonephritis recurrence, and drug nephrotoxicity.
• To describe antibody-mediated rejection (ABMR) based on the 2013 and 2017 Banff classifications.

Main Methods:

• Review of existing literature and Banff classification guidelines.
• Focus on histological findings and semiquantitative scoring.
• Synthesis of information on various transplant pathologies.

Main Results:

• Detailed interpretation of renal allograft biopsy findings.
• Identification of key factors in diagnosing rejection, infection, and other complications.
• Updated description of antibody-mediated rejection (ABMR).

Conclusions:

• Accurate biopsy interpretation is essential for effective renal transplant management.
• The Banff classification provides a framework for diagnosing and classifying rejection, including ABMR.
• Comprehensive understanding of transplant pathology guides treatment and improves graft survival.