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Renal transplant pathology (view source)
Revision as of 16:20, 11 November 2011
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'''Renal transplant pathology''' is grouped with the ''[[medical kidney diseases]]'', as this one leads to the other, and many renal transplants have recurrence of the pathology that lead to renal failure. | '''Renal transplant pathology''' is grouped with the ''[[medical kidney diseases]]'', as this one leads to the other, and many renal transplants have recurrence of the pathology that lead to renal failure. | ||
=Rejection | =Rejection= | ||
There is a consensus on categories - known as "Banff 97". | |||
==Overview== | |||
Allograft biopsy categories (Banff 97):<ref name=Ref_DARP400>{{Ref DARP|400}}</ref> | |||
{| class="wikitable" | |||
! Type | |||
! Key morphologic finding | |||
|- | |||
| Normal | |||
| no inflammation | |||
|- | |||
| Suspicious for acute rejection | |||
| focal mild tubulitis (1-4 mononuclear cells/tubular cross section) | |||
|- | |||
| Acute/active rejection | |||
| tubulitis (>4 mononuclear cells/tubular cross section); see separate table for grading | |||
|- | |||
| Chronic/sclerosing allograft nephropathy | |||
| interstitial fibrosis and tubular atrophy; see separate table for grading | |||
|} | |||
===Acute/active rejection=== | |||
Acute/active rejection in allograft biopsies (Banff 97):<ref name=Ref_DARP400>{{Ref DARP|400}}</ref> | |||
{| class="wikitable" | |||
! Grade | |||
! Key morphologic finding | |||
|- | |||
| IA | |||
| 4< mononuclear cell/tubular cross section ''or'' 10 tubular cells <10; >25% of parenchyma | |||
|- | |||
| IB | |||
| >10 mononuclear cell/tubular cross section ''or'' 10 tubular cells; >25% of parenchyma | |||
|- | |||
| IIA | |||
| mild-to-moderate intimal arteritis; <=25% of luminal area | |||
|- | |||
| IIB | |||
| severe intimal arteritis; >25% of luminal area | |||
|- | |||
| III | |||
| transmural arteritis and/or [[fibrinoid necrosis]] | |||
|} | |||
===Chronic/sclerosing allograft nephropathy=== | |||
Chronic rejection (Banff 97):<ref name=Ref_DARP400>{{Ref DARP|400}}</ref> | |||
{| class="wikitable" | |||
! Grade | |||
! Key morphologic finding | |||
|- | |||
| Grade 1 | |||
| mild interstitial fibrosis and tubular atrophy | |||
|- | |||
| Grade 2 | |||
| moderate interstitial fibrosis and tubular atrophy | |||
|- | |||
| Grade 3 | |||
| severe interstitial fibrosis and tubular atrophy | |||
|} | |||
==Predictors== | ==Predictors== | ||
*Associated with C4d+ IHC.<ref name=pmid1747954>Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Feucht HE, Felber E, Gokel MJ, Hillebrand G, Nattermann U, Brockmeyer C, Held E, Riethmüller G, Land W, Albert E. Clin Exp Immunol. 1991 Dec;86(3):464-70. PMID 1747954.</ref> | *Associated with C4d+ IHC.<ref name=pmid1747954>Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection. Feucht HE, Felber E, Gokel MJ, Hillebrand G, Nattermann U, Brockmeyer C, Held E, Riethmüller G, Land W, Albert E. Clin Exp Immunol. 1991 Dec;86(3):464-70. PMID 1747954.</ref> | ||