Progress in Pathological Diagnosis after Kidney Transplantation: Current Trend and Future Perspective

Area of Science:

• Nephrology
• Transplant Surgery
• Pathology

Background:

• Kidney transplantation (KT) survival has improved due to advances in immunosuppression, rejection management, and post-transplant care.
• Kidney allograft biopsy is the gold standard for diagnosing various injuries, including rejection, viral nephropathy, and toxicity.
• The Banff classification provides worldwide diagnostic criteria for rejection and polyomavirus-associated nephropathy.

Approach:

• This review discusses morphologic features of kidney allograft pathology based on the latest Banff classification.
• It examines the role of for-cause and protocol biopsies in early detection and treatment of allograft injury.
• The review also considers preimplantation biopsies in deceased and living donors for prognostic assessment and donor management.

Key Points:

• Kidney allograft biopsy is essential for diagnosing rejection, virus-induced nephropathy, calcineurin inhibitor toxicity, and glomerular diseases.
• Protocol biopsies aid in early detection and treatment of subclinical allograft injury.
• Preimplantation biopsies offer insights into donor kidney health and potential long-term outcomes.

Conclusions:

• Kidney allograft biopsy, guided by the Banff classification, remains vital for diagnosing and managing post-transplant complications.
• Protocol and preimplantation biopsies offer valuable data for optimizing patient and donor care.
• Future perspectives involve integrating new technologies to further refine diagnostic and prognostic capabilities.