1593 THE USE OF THE RENAL BIOPSY TO PREDICT ALLOGRAPH REJECTTCN PEDIATRIC KIDNEY TRANSPLANT RECIPIENT

Abstract

During an eight year period, 127 kidney transplants were performed on children and adolescents at the University of Florida. Seventy-three kidney biopsies were performed on 52 of these recipients (mean age 13 years) to elucidate deterioration of allograft function. Specimens were stained for routine light microscopy and immunofluorescence. Glomerular, tubular, interstitial, arteriole and arterial abnormalities were assessed by a 117 item survey of renal pathology. Fifty-six items described the distribution of pathologic changes and the remainder were graded observations of histologic abnormalities. The results were statistically evaluated in search of features that predicted the loss of the allograft within one year of the biopsy. Glomerular hypercellularity, swelling of the mesangial, endothelial and epithelial cells, encroachment on glomerular vascular space, basement membrane splitting, arteriolar wall hyperplasia, and arterial luminal compromise were associated with allograft rejection. Related items such as luminal compromise and cell swelling were strongly correlated in individual biopsy specimens. When two or three of these features were present in a specimen, the allograft was almost certain to be rejected within a year. Tubular changes, interstitial fibrosis or mononuclear cell infiltrates did not predict allograft rejection. Only half of the specimens had positive iirmunofluorescence reactions and none predicted allograft loss.