The predictive value of percutaneous biopsies from human renal allografts with early impaired function

A semiquantitative histological analysis was performed on 84 percutaneous biopsies 0-60 days post transplant from 66 grafts with clinical rejection, decreasing graft function of unknown etiology or persisting anuria. The presence of 1 or more of 3 histological lesions was associated with 100% graft loss within 1 year. The lesions were: infarction, glomerular capillary thrombosis, and arterial/arteriolar thrombosis. Since the detection of these severe lesions only permitted prediction of an unfavourable course in 72% of all grafts that were subsequently lost, a system was elaborated utilizing the sum of scores of 12 histological and 4 clinical parameters. This system failed to improve the prognostic value of the biopsy since diagnostic specificity as well as sensitivity was slightly lower by this method. The conclusion is that a graft biopsy performed during early graft failure has a high predictive value for graft loss if infarction, arterial thrombosis or glomerular capillary thrombosis is present; however the predictive value of a negative test is low.