Journal of Clinical & Experimental Pathology
Open Access

Abstract

Transplantation across HLA and ABO barriers is now possible with pre-transplant desensitization for highly sensitized patients, but recipients of HLA incompatible allograft are at increased risk of rejection and graft loss. 745 renal transplant biopsies, including 380 protocol biopsies at 1, 3, 6 and 12 months post-transplant, from 129 recipients of HLA-incompatible kidney allograft, with follow up of more than 1 year (median 3 years) at the Johns Hopkins Hospital were analyzed. Biopsyproven rejection was associated with approximately 30% lower 5 year graft survival. Subclinical rejections were identified by protocol biopsies in a significant proportion of patients: 36% for cell mediated rejection (CMR) and 13% for antibody mediated rejection (AMR). Protocol biopsies detected glomerulitis, a feature of AMR and an important risk factor for development of chronic transplant glomerulopathy, in 41% of all biopsies performed in the first year post transplant. Transplant glomerulopathy within the first year post transplant is associated with worse graft survival and was observed in 22% of patients in this study. Transplant glomerulopathy at 1year was detected by protocol biopsies in approximately 75% of cases. Arteritis was noted in the graft of approximately 30% patients. Protocol biopsies detected about half of the arteritis in the renal grafts. Preliminary analysis of the data did not show significant association of arteritis with worse graft survival. Theobservation support the value of protocol biopsies performed serially after transplantation in revealing early subclinical lesions amenable to treatment, and improving graft survival.

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