Abstract
Kidney transplantation has been effectively used as therapy for end-stage kidney disease, thanks to advances in the surgical, immunologic, and therapeutic realms. Decreased mortality and improved quality of life are cited among reasons to continue to pursue transplantation in the growing number of patients with chronic kidney disease (Tonelli et al. Am J Transplant 11(10):2093–2109, 2011). Unfortunately, however, renal allografts are subject to a variety of injuries, including physical, ischemic, immunologic, infectious, therapy-induced, and neoplastic, in addition to the ever-present threat of recurrent and de novo disease. Renal biopsy remains a mainstay in diagnosing and categorizing the type of injury present, so as to best inform the clinical approach (Williams et al. Nat Rev Nephrol 8(2):110–121, 2012). Timely and accurate representation of the histopathologic features present in a representative sample of renal allograft tissue, combined with appropriate ancillary testing, such as immunohistochemical (IHC) stains and molecular-based tests, are necessary to facilitate the best clinical approach to an individual patient and support optimal survival of the graft. This chapter highlights key pathologic features of the common and significant types of injury to which renal allografts are subject, and discusses key diagnostic features of each.
This is a preview of subscription content, log in via an institution to check access.
References
Adam B, Randhawa P et al (2014) Banff Initiative for Quality Assurance in Transplantation (BIFQUIT): reproducibility of polyomavirus immunohistochemistry in kidney allografts. Am J Transplant 14(9):2137–2147. https://doi.org/10.1111/ajt.12794
Allen UD, Preiksaitis JK et al (2013) Epstein-Barr virus and posttransplantlymphoproliferative disorder in solid organ transplantation. Am J Transplant 13:107–120. https://doi.org/10.1111/ajt.12104
Badiee P, Alborzi A (2011) Invasive fungal infections in renal transplant recipients. Exp Clin Transplant 6:355–362
Bloom RD, Bromberg JS et al (2017) Cell-free DNA and active rejection in kidney allografts. J Am Soc Nephrol 28:2221–2232. https://doi.org/10.1681/ASN.2016091034
Celik B, Shapiro R et al (2003) Polyomavirus allograft nephropathy: sequential assessment of histologic viral load, tubulitis, and graft function following changes in immunosuppression. Am J Transplant 3(11):1378–1382
Cockfield SM, Moore RB et al (2010) The prognostic utility of deceased donor implantation biopsy in determining function and graft survival after kidney transplantation. Transplantation 89(5):559–566. https://doi.org/10.1097/TP.0b013e3181ca7e9b
Colvin RB, Mauiyyedi S (2008) Pathology of kidney transplantation. In: Knechtle MP (ed) Kidney transplantation principles and practice, 6th edn. Saunders, Philadelphia, pp 383–415
Cosio FG, Amer H et al (2007) Comparison of low versus high tacrolimus levels in kidney transplantation: assessment of efficacy by protocol biopsies. Transplantation 83(4):411–416. https://doi.org/10.1097/01.tp.0000251807.72246.7d
El Ters M, Grande JP et al (2013) Kidney allograft survival after acute rejection, the value of follow-up biopsies. Am J Transplant 13(9):2334–2341. https://doi.org/10.1111/ajt.12370
Farkash EA, Colvin RB (2012) Diagnostic challenges in chronic antibody-mediated rejection. Nat Rev Nephrol 8(5):255–257. https://doi.org/10.1038/nrneph.2012.61
Farris AB, Chan S et al (2014) Banff fibrosis study: multicenter visual assessment and computerized analysis of interstitial fibrosis in kidney biopsies. Am J Transplant 14(4):897–907. https://doi.org/10.1111/ajt.12641
Farrugia D, Mahboob S et al (2014) Malignancy-related mortality following kidney transplantation is common. Kidney Int 85(6):1395–1403. https://doi.org/10.1038/ki.2013.458
Haas M, Sis B et al (2014) Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant 14(2):272–283. https://doi.org/10.1111/ajt.12590
Hotta K, Fukasawa Y et al (2012) Granulomatous tubulointerstitial nephritis in a renal allograft: three cases report and review of literature. Clin Transpl 26(Suppl 24):70–75. https://doi.org/10.1111/j.1399-0012.2012.01643.x
Joh K, Morozumi K et al (2006) Symposium: evaluating the reproducibility of pathological diagnosis using the 1997 Banff classification update. Clin Transpl 20(Suppl 15):53–60
Lebranchu Y, Baan C et al (2013) Pretransplant identification of acute rejection risk following kidney transplantation. Transpl Int 27(2):129–138. https://doi.org/10.1111/tri.12205
Loupy A, Vernerey D et al (2015) Subclinical rejection phenotypes at 1 year post-transplant and outcome of kidney allografts. J Am Soc Nephrol 26(7):1721–1731. https://doi.org/10.1681/ASN.2014040399
Mannon RB, Matas AJ et al (2010) Inflammation in areas of tubular atrophy in kidney allograft biopsies: a potent predictor of allograft failure. Am J Transplant 10(9):2066–2073. https://doi.org/10.1111/j.1600-6143.2010.03240.x
Marinaki S, Lionaki S et al (2013) Glomerular disease recurrence in the renal allograft: a hurdle but not a barrier for successful kidney transplantation. Transplant Proc 45(1):3–9. https://doi.org/10.1016/j.transproceed.2012.12.021
Moreso F, Ibernon M et al (2006) Subclinical rejection associated with chronic allograft nephropathy in protocol biopsies as a risk factor for late graft loss. Am J Transplant 6:747–752. https://doi.org/10.1111/j.1600-6143.2005.01230.x
Morgans AK, Reshef R et al (2010) Posttransplant lymphoproliferative disorder following kidney transplant. Am J Kidney Dis 55(1):168–180. https://doi.org/10.1053/j.ajkd.2009.09.026
Nadasdy T (2014) Thrombotic microangiopathy in renal allografts: the diagnostic challenge. Curr Opin Organ Transplant 19(3):283–292. https://doi.org/10.1097/MOT.0000000000000074
Naesens M, Kuypers DR et al (2009) Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol 4(2):481–508. https://doi.org/10.2215/CJN.04800908
Nankivell BJ, Alexander SI (2010) Rejection of the kidney allograft. N Engl J Med 363(15):1451–1462. https://doi.org/10.1056/NEJMra0902927
Nickeleit V, Mihatsch MJ (2004) Polyomavirus allograft nephropathy and concurrent acute rejection: a diagnostic and therapeutic challenge. Am J Transplant 4(5):838–839
Nickeleit V, Mengel M et al (2015) Renal transplant pathology. In: Jennette JC, Olson JL, Silva FG, D’Agati VD (eds) Heptinstall’s pathology of the kidney, vol 2. Lippincott Williams & Wilkins, Philadelphia, pp 1331–1461
O’Neill WC (2014) Renal relevant radiology: use of ultrasound in kidney disease and nephrology procedures. Clin J Am Soc Nephrol 9(2):373–381. https://doi.org/10.2215/CJN.03170313
O’Neill WC, Baumgarten DA (2002) Ultrasonography in renal transplantation. Am J Kidney Dis 39(4):663–678
Ponticelli C, Moroni G et al (2014) De novo glomerular diseases after renal transplantation. Clin J Am Soc Nephrol 9(8):1479–1487. https://doi.org/10.2215/CJN.12571213
Racusen LC, Solez K et al (1999) The Banff 97 working classification of renal allograft pathology. Kidney Int 55(2):713–723
Racusen LC, Colvin RB et al (2003) Antibody-mediated rejection criteria – an addition to the Banff 97 classification of renal allograft rejection. Am J Transplant 3(6):708–714
Rao KV, Kasiske BL et al (1989) Acute graft rejection in the late survivors of renal transplantation. Clinical and histological observations in the second decade. Transplantation 47(2):290–292
Reeve J, Einecke G et al (2009) Diagnosing rejection in renal transplants: a comparison of molecular- and histopathology-based approaches. Am J Transplant 9(8):1802–1810. https://doi.org/10.1111/j.1600-6143.2009.02694.x
Reeve J, Sellarés J et al (2013) Molecular diagnosis of T cell-mediated rejection in human kidney transplant biopsies. Am J Transplant 13(3):645–655. https://doi.org/10.1111/ajt.12079
Salvadori M, Rosso G et al (2015) Update on ischemia-reperfusion injury in kidney transplantation: pathogenesis and treatment. World J Transplant 5(2):52–67. https://doi.org/10.5500/wjt.v5.i2.52
Sellarés J, de Freitas DG et al (2012) Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant 12(2):388–399. https://doi.org/10.1111/j.1600-6143.2011.03840.x
Solez K, Axelsen RA et al (1993) International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 44(2):411–422
Solez K, Colvin RB et al (2007) Banff’05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy (‘CAN’). Am J Transplant 7(3):518–526. https://doi.org/10.1111/j.1600-1643.2006.01688.x
Solez K, Colvin RB et al (2008) Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 8(4):753–760. https://doi.org/10.1111/j.1600-6143.2008.02159.x
Stallone G, Infante B et al (2015) Management and prevention of post-transplant malignancies in kidney transplant recipients. Clin Kidney J 8(5):637–644. https://doi.org/10.1093/ckj/sfv054
Walker PD, Cavallo T et al (2004) Practice guidelines for the renal biopsy. Mod Pathol 17(12):1555–1563
Wang CJ, Wetmore JB et al (2015) The donor kidney biopsy and its implications in predicting graft outcomes: a systematic review. Am J Transplant 15(7):1903–1914. https://doi.org/10.1111/ajt.13213
Wiebe C, Gibson IW et al (2012) Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant 12(5):1157–1167. https://doi.org/10.1111/j.1600-6143.2012.04013.x
Williams WW, Taheri D et al (2012) Clinical role of the renal transplant biopsy. Nat Rev Nephrol 8(2):110–121. https://doi.org/10.1038/nrneph.2011.213
Wu K, Budde K et al (2014) The severity of acute cellular rejection defined by Banff classification is associated with kidney allograft outcomes. Transplantation 97(11):1146–1154. https://doi.org/10.1097/01.TP.0000441094.32217.05
Acknowledgements
The authors would like to express their sincere thanks to Ms. Chandler Carroll for her assistance with formatting the citations.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this entry
Cite this entry
Jones, K.A., Windham, A., Rao, A. (2018). Pathology of Kidney Transplantation. In: Ramirez, C., McCauley, J. (eds) Contemporary Kidney Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-19617-6_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-19617-6_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-19616-9
Online ISBN: 978-3-319-19617-6
eBook Packages: MedicineReference Module Medicine