Clinical considerations of renal allograft pathology

Eleven out of 31 cases of living renal allografts lost their graft functions. Causes of graft loss were acute rejection in eight cases chronic rejection in one, graft rupture in one, and death due to meningitis with good graft function in one case. Five renal allografts and two biopsy specimens obtained after acute irreversible rejection and one renal allograft due to acute tubular necrosis an rupture were reviewed. We evaluated the correlation between these findings and the irreversibility of renal graft functions. All removed allografts and biopsies demonstrated interstitial edema and cell infiltration. Vascular pathology due to acute irreversible rejection revealed a high level of severity with fibrinoid necrosis and luminal obliteration. These findings suggested that graftectomy and cessation of immunosuppressants were indicated.