Histopathological Findings in Protocol Biopsies of Transplanted Kidneys

Authors: T. Tichý 1;  M. Tichý 1;  J. Zadražil 2;  K. Krejčí 2;  Horčička;  V. jr. 2;  S. Al-Jabry 2;  P. Bachleda 3;  V. Král 3;  Dušek J.+ 1
Authors‘ workplace: Ústav patologie LF UP a FN, Olomouc 2III. interní klinika LF UP a FN, Olomouc3I. chirurgická klinika LF UP a FN, Olomouc 1
Published in: Čes.-slov. Patol., , 2003, No. 1, p. 11-16


Fourty eight patients with cadaveric kidney allografts treated by cyclosporin A (CSA) or tacrolimus(FK506) underwent protocol graft biopsies at 1, 3 and 12 months after transplantation, and110 biopsy specimens were obtained. Histologic diagnosis was made according to the Banff scheme.The main cause of the graft instability at 1 and 3 months was acute clinical rejection, thesebiopsies showed all known histological patterns of tubulointersticial and vascular rejection. Acutetubular nephropathy was found in 13% and borderline changes or nephrotoxicity in 8.7% ofinstable grafts. Specifically, we focused on the occurence of subclinical rejection and toxic reactionsin stable renal allografts. Of these, 36.1% showed histological patterns of acute tubulointersticialand vascular rejection. The Banff score of subclinical rejection was significantly lower thanin clinically apparent rejection. CSA and tacrolimus nephrotoxicity were seen in 14.2%, 19.5% and27.2% of specimens at 1, 3 and 12 months, respectively. In over one half of the identified cases ofnephrotoxicity neither increased level of immunosuppresion nor features of allograft dysfunctionwere found. At 12 months, 45.5% of specimens showed mild chronic transplant nephropathy and18.1% moderate chronic transplant nephropathy. Normal morphology was found in 36.4% of biopsies.We found a high prevalence of subclinical rejection and nephrotoxicity in the studied cohort.We conclude that protocol biopsy is a reliable method in the diagnosis of clinically silent, aswell as clinically apparent, disorders of the transplanted kidney.

Key words:
renal transplantation - protocol biopsy - subclinical rejection - nephrotoxicity

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Anatomical pathology Forensic medical examiner Toxicology

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Czecho-Slovak Pathology

2003 Issue 1

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