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 - overview

Rejection can be:

Acute.
Chronic.
Acute-on-chronic.

Predictors

Associated with C4d+ IHC.^[1]
Mean graft survival is ~4 years for C4d+ interstitial capillaries vs. ~8 years for C4d- renal grafts.^[2]

Acute rejection

Acute rejection has a standardized classification Banff classification.^[3]

Diagnosis of acute rejection requires:

Serology.
IHC (C4d).
- This is somewhat debated.
Morphology.

Infection

Polyomavirus

This bad-boy is associated with failure of transplanted kidneys.^[4]
Treatment: reduce immunosuppression.^[5]

Microscopic features:^[5]

Ground glass-like nuclear inclusions.
Nuclear enlargement.

Transplant-related pathology

Transplant glomerulopathy

Microscopic:

Tram-tracking of basement membrane.

DDx (tram-tracking):

MPGN.
Thrombotic microangiopathy (TMA).

Calcineurin-inhibitor toxicity

Calcineurin-inhibitors (e.g. cyclosporine,^[6], tacrolimus^[7]) toxicity can induce a thrombotic microangiopathy.
Hyaline arteriopathy with a peripheral and nodular distribution (chronic toxicity).

References

↑ 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.
↑ Impact of humoral alloreactivity early after transplantation on the long-term survival of renal allografts. Lederer SR, Kluth-Pepper B, Schneeberger H, Albert E, Land W, Feucht HE. Kidney Int. 2001 Jan;59(1):334-41. PMID 11135088.
↑ Racusen LC, Solez K, Colvin RB, et al. (February 1999). "The Banff 97 working classification of renal allograft pathology". Kidney Int. 55 (2): 713–23. doi:10.1046/j.1523-1755.1999.00299.x. PMID 9987096. http://www.nature.com/ki/journal/v55/n2/full/4490631a.html.
↑ Mackenzie EF, Poulding JM, Harrison PR, Amer B (1978). "Human polyoma virus (HPV)--a significant pathogen in renal transplantation". Proc Eur Dial Transplant Assoc 15: 352–60. PMID 216990.
↑ ^5.0 ^5.1 Nickeleit, Volker; Singh, Harsharan K. Polyomavirus Allograft Nephropathy: Clinico-Pathological Correlations. URL: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=eurekah&part=A74503#A74539. Accessed on: 8 November 2010.
↑ Zarifian A, Meleg-Smith S, O'donovan R, Tesi RJ, Batuman V (June 1999). "Cyclosporine-associated thrombotic microangiopathy in renal allografts". Kidney Int. 55 (6): 2457–66. doi:10.1046/j.1523-1755.1999.00492.x. PMID 10354295.
↑ Fogo, Agnes; Bruijn, Jan A.; Cohen, Arthur H.; Colvin, Robert B.;Jennette, J. Charles (2006). Fundamentals of Renal Pathology (1st ed.). Springer. pp. 203. ISBN 978-0387311265.

[pmid1747954-1] 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.

[pmid11135088-2] Impact of humoral alloreactivity early after transplantation on the long-term survival of renal allografts. Lederer SR, Kluth-Pepper B, Schneeberger H, Albert E, Land W, Feucht HE. Kidney Int. 2001 Jan;59(1):334-41. PMID 11135088.

[pmid9987096-3] Racusen LC, Solez K, Colvin RB, et al. (February 1999). "The Banff 97 working classification of renal allograft pathology". Kidney Int. 55 (2): 713–23. doi:10.1046/j.1523-1755.1999.00299.x. PMID 9987096. http://www.nature.com/ki/journal/v55/n2/full/4490631a.html.

[pmid216990-4] Mackenzie EF, Poulding JM, Harrison PR, Amer B (1978). "Human polyoma virus (HPV)--a significant pathogen in renal transplantation". Proc Eur Dial Transplant Assoc 15: 352–60. PMID 216990.

[Nickeleit-5] 5.0 ^5.1 Nickeleit, Volker; Singh, Harsharan K. Polyomavirus Allograft Nephropathy: Clinico-Pathological Correlations. URL: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=eurekah&part=A74503#A74539. Accessed on: 8 November 2010.

[pmid10354295-6] Zarifian A, Meleg-Smith S, O'donovan R, Tesi RJ, Batuman V (June 1999). "Cyclosporine-associated thrombotic microangiopathy in renal allografts". Kidney Int. 55 (6): 2457–66. doi:10.1046/j.1523-1755.1999.00492.x. PMID 10354295.

[Ref_FoRP203-7] Fogo, Agnes; Bruijn, Jan A.; Cohen, Arthur H.; Colvin, Robert B.;Jennette, J. Charles (2006). Fundamentals of Renal Pathology (1st ed.). Springer. pp. 203. ISBN 978-0387311265.

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Renal transplant pathology

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