Pathology of kidney transplantation

Abstract

The graft is vulnerable to all of the diseases that may affect the native kidney but exhibits several special patterns of damage. Fine needle aspiration has provided much useful information about the character of cellular infiltrates and the expression of various antigens but core biopsy remains the most useful diagnostic tissue procedure. Rejection (cellular, glomerular and vascular) is the major target for graft biopsies but other patterns may be encountered and special diagnostic problems include recurrent or de novo glomerulonephritis scarring without specific features and the normal or near normal biopsy. Early experience with Cyclosporin A given in high doses delineated specific vascular and tubular lesions but the toxic changes are more subtle in current dosage protocols. Thrombotic complications are more common in patients’ receiving Cyclosporin A and need to be distinguished from the haemotytic uraemic syndrome. Immunofluorescence and electron microscopy are as important in the examination of graft as of natural kidney biopsies and may detect evidence of glomerulonephols - recurrent or de novo - that is not apparent by light microscopy. Assessment of the glomerular cell population in evolving glomerulonephritis and glomerulopathy may provide insights into some of the mechanisms of damage and “proliferation” in native kidney disease.