Renal Allograft Biopsy Findings in Live-related Renal Transplant Recipients

Objective: To determine the pattern of histopathology in living- related, kidney transplant recipients (KTRs) from a transplant centre in Khyber Pakhtunkhwa (KPK), Pakistan. Study Design: Descriptive, observational study. Place and Duration of Study: Institute of Kidney Diseases, Peshawar, from August 2008 to July 2018. Methodology: A retrospective review of graft biopsy reports and clinical charts from living-related, kidney transplant recipients was carried out. Allograft biopsies were done for graft dysfunction with no apparent cause. The biopsy pathology was classified according to updated Banff classifications. The descriptive statistics were used to tabulate the results. Results: Out of the 55 biopsies, 51 (92.73%) were from males with mean age of 34.35 +/- 9.40 years. Out of 52 percutaneous biopsies, 10 (19.23%) belonged to the normal category. Category 2 (borderline rejection) and 3 (acute/active cellular rejection) were seen in three (5.7%) and one (1.9%) cases, respectively. Interstitial fibrosis/tubular atrophy (Banff Category 5) was observed in 18 (34.62%) cases. Banff Category 6 (others) was seen in 19 (36.5%) cases, in which calcineurin inhibitors (CNI) toxicity was commonest ( 17 [89.4%] of 19 cases). Mixed lesions were found in 19 (36.5%) cases. Out of the 19 mixed category cases, 12 (63.16%) showed both Category 3 and Category 5 changes with most of the cases showing mild to moderate IF/TA; while one case had severe IF/TA. Three graft nephrectomies were done, one each for recurrent oxalosis, nephroblastoma and fungal infection. Conclusion: Among the studied specimens, mixed lesions were the predominant findings, followed by others (mostly CNI toxicity) and IFTA categories. The frequency of acute/active rejections was low and that of chronic changes higher, in keeping with delayed biopsies.

Automated summary

The study aimed to determine the histopathological pattern in living-related kidney transplant recipients from a transplant center in Khyber Pakhtunkhwa, Pakistan. Mixed lesions were the predominant findings, followed by others (mostly CNI toxicity) and IFTA categories. The frequency of acute/active rejections was low, while chronic changes were higher, in line with delayed biopsies.