Kidney Transplant pathology (Renal transplant pathology, cadaveric renal transplant (CRT), living related donor..)

General: Renal transplantation was widely adopted around the 1960's and became more successful around 1983 with the introduction of calcineurin inhibitors ("modern" immunosuppressants). Nevertheless, most patients have one or more episodes of graft dysfunction over their lifetime, and rejection remains the primary cause of graft failure. Renal biopsy is still considered the most sensitive method of identifying rejection.

Gross: At least two cores are recommended, as early rejection is notoriously "focal," and thus can be absent on a small biopsy. By the Banff 1997 consensus criteria, an adequate biopsy is defined by 10 or more glomeruli and two arteries; this is considered required for a negative diagnosis. However, positive diagnoses can be made on less material.

Microscopic: (See specific diagnostic entities for detailed microscopic descriptions.)

Differential Diagnosis:

• Acute Tubular Necrosis
• Drug Toxicity
• Infection
• Perfusion Injury
• Post Transplant Lymphoproliferative Disease
• Rejection
  • ((Kidney Cellular Rejection|Cellular (T-cell mediated) Rejection))
  • Chronic Rejection (chronic allograft nephropathy)
  • Kidney Humoral Rejection|Humoral (antibody mediated) Rejection))

Stains:

• Positive:
• Negative:
• Suggested, focused panel: C4d, CD3, CD20, CD68, trichrome, PAS, silver.

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Cases:

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