Diagnosis Of Renal Transplant Rejection Research Articles

COVID-19 as a cause of acute kidney transplant rejection: clinical and morphological analysis of a fatal case report

COVID-19 against the background of the respiratory system damage often causes changes in the morpho-functional state of the kidneys, accelerates the progression and development of complications of chronic kidney disease, and is the cause of a high mortality rate in kidney transplant recipients. In the article, the authors conduct a detailed clinical and morphological analysis of a fatal case report of acute kidney transplant rejection of antibody-mediated and cell-mediated genesis, the development of which was determined by the presence of COVID-19 in the patient. The authors emphasize that the morphological study is crucial for the diagnosis of renal transplant rejection. This clinical and morphological analysis of a case report shows the need for an individual approach to this category of patients for the purpose of timely diagnosis, treatment and prevention of COVID-19.

Diagnosis of renal transplant rejection: Banff classification and beyond.

Diagnosis of renal transplant rejection is dependent on interpretation of renal allograft biopsies. The Banff Classification of Allograft Pathology, which was developed as a standardized working classification system in 1991, has contributed to the standardization of definitions for histologic injuries resulting from renal allograft rejections and provided a universal grading system for assessing these injuries. It has also helped to provide insight into the underlying pathogenic mechanisms that contribute to transplant rejection. In addition to histological and immunologic parameters, molecular tools are now being used to facilitate the diagnosis of rejection. In this review, I will discuss morphologic features of renal transplant rejections as well as major revisions and pitfalls of the Banff classification system, and provide future perspectives.

Advances in the diagnosis of renal transplant rejection

This review attempts to cover the main areas of recent development in renal transplantation, from the viewpoint of the renal histopathologist. There are various different types of donor kidney, including the ‘non-heart beating donor' and the possibility of xenotransplantation. These pose differing problems in biopsy interpretation. Non-heart beating donor kidneys always develop severe acute tubular necrosis in the early weeks; this causes difficulty in the detection of acute rejection at this stage, which may be resolved by fine needle aspiration biopsy, urine cytology and/or repeated ‘protocol' needle core biopsy. Recent developments have improved the performance of each method, but the best course remains a subject for debate. For renal transplant pathologists, the Banff classification of renal transplant pathology is perhaps the most important practical development in recent years. This scheme has a proven use in research projects, but its role in routine practice is not yet universally accepted. It has allowed the development of the histological criteria of rejection to become an ongoing process of refinement, facilitated by wide electronic discussion through the Internet. Prospects for predicting long-term graft survival from early transplant biopsies are discussed, including the development of a ‘chronic allograft damage index'. Other areas where developments may come in the near future include studies of cytokines and adhesion molecules, lymphocyte markers, semi-automated morphometric evaluation of biopsies and monitoring the effects of novel immunosuppressive drugs.

Diagnosis of renal transplant rejection in the cyclosporine era.

The introduction in 1983 of cyclosporine as a prophylactic immunosuppressive agent has contributed to improved renal allograft survival at many transplant centers. However, in view of its profound nephrotoxic potential, the use of this drug in renal transplant patients has caused diagnostic confusion. An accurate assessment of whether the allograft dysfunction is from drug overdose or from acute rejection is important before one can manage the problem appropriately. The two practical measures that would help in distinguishing acute rejection from cyclosporine-induced toxicity are 1) a trial of cyclosporine dose-reduction and subsequent assessment of renal function, and 2) histologic assessment of the renal allograft biopsy specimen. In recent years, several new diagnostic techniques to assess the immunologic activity within the graft environment have been developed that could further enhance our discriminating ability. However, these sophisticated techniques are not readily available to most clinicians who are currently managing patients with graft dysfunction. This article focuses on the different methods of distinguishing rejection from cyclosporine-induced toxicity. The data were abstracted from relevant papers published in the scientific literature during the past 12 months.

Usefulness of Thromboxane B2 in Diagnosis of Renal Transplant Rejection

Abstract Morelet et al. (1) assessed the usefulness of sequential urinary albumin measurements in 16 renal allograft recipients, eight with and eight without acute graft-rejection episodes. They concludedthat the urinary albumin/creatinine ratio is poorly specific in the diagnosis of acute renal rejection, as shown by a high proportion of false-positive results. In addition, they commented on similar findings-poor specificity and poor positive predictive value-for other urinary components, e.g., β2-microglobulin, neopterin, renal tubular enzymes, thromboxane B2 (TxB2), interleukin-2, and solubleIL-2 receptor.

Anti-platelet Monoclonal Antibody P256 in the Diagnosis of Renal Transplant Rejection

Platelets labeled in vitro with In-111 have a recognized place in the diagnosis of renal transplant rejection. Following their introduction for imaging thrombi, radio-labeled anti-platelet antibodies may also have a role in the diagnosis of transplant rejection. Four of 11 patients with recently donated transplants had biopsy-proven acute rejection episodes close to the time of administration of In-111 P256 Fab' fragment, which recognizes the IIb-IIIa fibrinogen receptor on primate platelets. The transplant-to-background count rate at 3 and 24 hours after these injections were 2.2 (SE 0.14) and 2.3 (0.23), respectively, almost identical to the ratios, 2.0 (0.1) and 2.2 (0.11), recorded at the corresponding times after 19 injections of P256 Fab' that were remote in timing from rejection episodes. P256 Fab' may have value in the detection of postoperative venous thrombosis, but it has no value for the detection of transplant rejection.

Correlation of radionuclide and ultrasound studies with biopsy findings for diagnosis of renal transplant rejection

The diagnosis of early renal transplant rejection is of the utmost importance to the transplant recipient. Unfortunately, such a diagnosis is often extremely difficult to make. In an attempt to clarify this issue we retrospectively evaluated 35 patients with the presenting diagnosis of rejection for the correlation of comparable radionuclide (RN) and ultrasound (US) examinations with biopsy findings. In 21 patients with heavy interstitial mononuclear cell infiltration, 22 of 23 serial RN studies within forty-eight hours of biopsy were positive for rejection. Only 3 of 14 comparable US studies were positive for rejection. When examinations performed within approximately fourteen days were evaluated, 7 of 11 RN studies were positive for rejection, while 2 of 9 comparable US studies were positive for rejection. However, in 14 patients with mild or no interstitial cellular infiltration, only 6 of 13 RN studies were positive, while all 4 US examinations were negative. In the group evaluated at approximately two weeks, 2 of 6 RN studies were positive, while 0 of 5 US studies were positive. We conclude that the serial RN study is more sensitive than US examination for the diagnosis of acute rejection. US, however, proved valuable in the identification of transplant complications (i.e., fluid collections, ascites, and hydronephrosis).

Accurate diagnosis of renal transplant rejection by indium-111 platelet imaging despite postoperative cyclosporin therapy.

Previous reports indicate that In-111 platelet scintigraphy (IPS) is a reliable test for the early diagnosis of acute post-operative renal transplant rejection (TR). However, the recent introduction of cyclosporin for post-transplantation immunosuppression requires that the diagnostic efficacy of IPS once again be established. Therefore, a prospective IPS study of 73 post-operative renal transplant recipients was conducted. Fourty-nine patients received cyclosporin and 24 patients did not receive this drug. Between these two patient groups, there were no significant differences in the diagnostic sensitivities (0.86 vs 0.80) and specificities (0.93 vs 0.84) with which TR was identified. We conclude that during the first two weeks following renal transplantation the cyclosporin treatment regimen used at our institution does not limit the reliability of IPS as a test for TR.

An Evaluation of Technetium-99m Tin Colloid—Its Value in the Diagnosis of Renal Transplant Rejection

The value of the Technetium-99m tin colloid (TTC) scan in the diagnosis of renal transplant rejection occurring more than 1 month following transplantation was assessed. To our knowledge, use of this agent has not previously been reported. Gamma camera imaging was performed on 15 occasions in 14 patients in whom plasma creatinine was rising and in three patients in whom renal function was stable. Both a qualitative and a quantitative assessment of images was made. The radioactivity recorded over the graft at 12-16 min post injection was expressed as a percentage of that recorded at 0-4 min. In the nine patients in whom graft perfusion was adequate to allow interpretation of the TTC scan and in whom rejection was diagnosed by biopsy (six cases) or on clinical grounds (three cases), the index ranged from 45 to 153%. In two patients the graft was poorly perfused and the accumulation of TTC was predictably low despite the presence of rejection. In the seven patients with either a stable creatinine or with rising creatinine not due to rejection, the index ranged from 5 to 43%. Previously reported studies have shown that sulphur colloids may be of value in diagnosing graft rejection. This study suggests that Tc99m tin colloid may be regarded as a suitable alternative scanning agent and that some simplification of data collection and analysis can be achieved.

Fine-Needle Aspiration Biopsy: A Reproducibility Study and a Correlation With the Tru-Cut Biopsy in the Evaluation of Renal Allotransplants

Forty patients receiving a living related donor kidney transplant in the last 12 months were subjected to evaluation by Fine Needle Aspiration Biopsies (FNABs) and Tru-cut biopsies. The reproducibility of the transplant aspiration cytology was tested by comparing 90 double FNABs (FNAB1 and FNAB2). Furthermore, the accuracy of FNABs was assessed by comparison with 30 kidney transplant Tru-cut biopsies obtained simultaneously. Statistical analysis showed no significant difference (P greater than 0.1) between FNAB1 and FNAB2 and both correlated positively with the Tru-cut biopsies. All the 25 acute rejection episodes documented by Tru-cut biopsies were positive in the simultaneously obtained FNABs. FNABs failed to diagnose histologically documented chronic rejection, humoral rejection, and a case of disseminated intravascular coagulation. In one case with deteriorating graft function, Tru-cut biopsy showed normal histology, yet transplant aspiration cytology showed cyclosporin nephrotoxicity. Sensitivity of transplant aspiration cytology was found to be 90.9% and specificity was 100%. We have concluded that FNAB when performed frequently, especially if double aspirates are obtained, is safe, sensitive and highly specific for diagnosis of renal transplant rejection. Humoral and chronic rejections are major limitations.

99Tcm-(tin) colloid scans in the evaluation of renal transplant rejection.

Technetium-99m-(tin) colloid uptake in renal transplants was quantified to evaluate rejection. A dynamic acquisition following i.v. injection of 110 MBq of this radiopharmaceutical enabled quantification of 15 to 20 min transplant uptake (PU), in terms of percentage of an injected dose after allowing for attenuation in the patient. An uptake ratio (UR) i.e. the ratio of 15 to 20 min uptake over the 0 to 5 min uptake was also derived. Normal values were obtained in 20 stable functioning transplants (normal PU less than or equal to 1%, normal UR less than or equal to 0.7). In 66 patients, PU and UR were compared with clinical, biochemical, histological and radiological, evidence of rejection. A sensitivity of 70% and specificity of 85% was obtained for this 99Tcm-(tin) colloid study in the diagnosis of renal transplant rejection.

Differential diagnosis of renal transplant rejection: is MR imaging the answer?

Differential diagnosis of renal transplant rejection: is MR imaging the answer?

1614 UTILITY OF TWO URINARY ENZYMES, N-ACETYL-BETA-D-GLUCOSAMINDASE (NAG) AND GAMMA-GLUTAMYL TRANSPEPTIDASE (GGT) AS INDICATORS OF RENAL ALLOGRAFT REJECTION

Urinary enzymes have been used in the diagnosis of renal transplant rejection. NAG, a lysosomal enzyme, and GGT, a brush border enzyme, were serially measured in 110 renal transplant patients. Sixty six patients had evidence of rejection, independent of enzymuria. Enzyme values were correlated with parameters used to determine rejection, including: serum creatinine, urine creatinine and urine output. Patients were stratified by rejection status and disease type. Maximum, minimum and mean values were analyzed. Receiver Operator Characteristic (ROC) curves were constructed to assess the sensitivity vs false positive rate of NAG and GGT in detecting rejection, with clinical rejection as the standard. Mean NAG values were different between rejectors and non-rejectors (p<0.01). Peak prerejection values for NAG in rejectors were not statistically different from overall peak values obtained from non-rejectors. However mean, pre-rejection NAG values were different from mean overall values for non-rejectors (p<0.01). Similar studies of GGT values failed to discriminate between the rejection and non-rejection groups. ROC curves revealed a marginal ability of NAG to detect rejection, while GGT had no ability. The relationship between the appearence of these enzymes in the urine and rejection is not simple enough to have clinical utility.

Indium (111In)-labelled platelets in the diagnosis of renal transplant rejection: preliminary findings.

Eleven patients with recent kidney transplants have undergone serial pelvic imaging after autologous platelet labelling with indium-111. Rejection was accompanied by marked platelet deposition in the graft, whereas acute tubular necrosis was characterized by minimal platelet accumulation. The method has been quantified by comparing counts over the graft to counts from a similar area on the opposite site, and appears to distinguish between the two main causes of renal failure after transplantation. In addition, complications of transplant surgery may be demonstrated.

99mTechnetium Sulfur Colloid Scanning in Diagnosis of Renal Transplant Rejection

To evaluate the possible presence of rejection 37 99mtechnetium sulfur colloid imaging procedures were done on 17 renal transplant patients. There was good correlation between the clinical diagnosis and the results of the technetium sulfur colloid images, with no falsely positive studies in the series. An illustrative case and a review of pertinent literature confirm this technique to be an excellent method for the early detection of renal transplant rejection.

The Diagnosis of Renal Transplant Rejection in Association with Acute Tubular Necrosis Using the Scintillation Camera

No AccessJournal of Urology1 Jun 1972The Diagnosis of Renal Transplant Rejection in Association with Acute Tubular Necrosis Using the Scintillation Camera Edward R. Weiss, William H. Blahd, G.T. Krishnamurthy, and Martin A. Winston Edward R. WeissEdward R. Weiss Current address: Nuclear Medicine Service, Wadsworth Hospital, Veterans Administration, Los Angeles, California 90025. More articles by this author , William H. BlahdWilliam H. Blahd More articles by this author , G.T. KrishnamurthyG.T. Krishnamurthy More articles by this author , and Martin A. WinstonMartin A. Winston More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)61171-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1972 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 107Issue 6June 1972Page: 917-921 Advertisement Copyright & Permissions© 1972 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Edward R. Weiss Current address: Nuclear Medicine Service, Wadsworth Hospital, Veterans Administration, Los Angeles, California 90025. More articles by this author William H. Blahd More articles by this author G.T. Krishnamurthy More articles by this author Martin A. Winston More articles by this author Expand All Advertisement PDF downloadLoading ...