Demographic and Histopathological Features of Graft Dysfunction in Renal Transplant Biopsies: A Retrospective Study

Renal allograft biopsy plays a crucial role in identifying the causes of graft dysfunction and determining treatment strategies accordingly. In addition to rejection, viral infections, drug toxicity, systemic diseases such as hypertension and diabetes, as well as recurrent or de novo glomerulonephritis, can also be diagnosed through biopsy. This study aims to evaluate the diagnoses of renal allograft biopsies in conjunction with the Banff criteria.

In our study, 44 renal transplant biopsies received at our pathology clinic between 2017 and 2024 were evaluated in terms of demographic, clinical, histopathological, and immunohistochemical features. Histopathological characteristics were scored according to the Banff 2019 criteria.

Among the cases, 70.5% (n = 31) were male, with a mean age of 45.16 years. The first transplantation had been performed in 97.7% of patients. A total of 77.3% of transplantations were from living donors, while 22.7% were from deceased donors. At the time of biopsy, the mean serum creatinine level was 4.03 ± 2.14 mg/dL (range: 0.70-8.50 mg/dL). Diagnoses included chronic active antibody-mediated rejection (ca-ABMR) (31.8%), active ABMR (18.2%), borderline changes (9.1%), polyomavirus nephropathy (9.1%), acute tubular necrosis (9.1%), recurrent/de novo glomerulonephritis (6.8%), acute T-cell-mediated rejection (TCMR) (4.5%), and chronic TCMR (4.5%). A statistically significant difference was observed in the Banff lesion scores of glomerulitis (P = .005), peritubular capillaritis (P = .002), and C4d staining (P = .001) between ABMR and TCMR. Three patients (6.8%) were deceased, while 41 patients (93.2%) survived.

The most common causes of graft dysfunction were ca-ABMR, active ABMR, borderline changes, and polyomavirus nephropathy. Kidney biopsy remains the gold standard for prompt initiation of appropriate treatment when graft dysfunction occurs.